House of Lords
Prisons: Health Services
(1 day, 11 hours ago)
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Baroness Morgan of Drefelin
To ask His Majesty’s Government what assessment they have made of the provision of health services in prisons.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, a full health needs assessment for every prisoner is undertaken at least every three years by NHS England, which then updates service specifications and commissions appropriate services to ensure that the health needs of offenders are being met. All 19 health service specifications for prisons and other detention environments are currently being updated to ensure that they remain fit for purpose and are expected to be published by March 2026.
Baroness Morgan of Drefelin (Lab)
My Lords, I thank my noble friend for her Answer. I have heard first hand, through the work of the charities the Prison Reform Trust and Revolving Doors, about the challenging and degrading experience that some prisoners have had trying to access healthcare. Does the Minister agree that there is a huge opportunity to make progress here with the development of better facilities in new prisons? Does she also agree that it be would a positive thing to include prison healthcare services in ICBs’ commissioning to ensure that people in secure settings have access to the advances and developments that are available in the community?
Baroness Merron (Lab)
I certainly agree with my noble friend that there are huge opportunities to improve healthcare for prisoners. On new prison design, I reassure her that all prison design will be fit for purpose because medical architects will be commissioned. That new design includes, for example, medical cells so that as many healthcare needs as possible can be met in prison. On my noble friend’s point about ICBs, it is a retained service, so it is not currently delegated to ICBs. It is the responsibility of health and justice commissioners to collaborate closely with ICBs to ensure continuity of care. The electronic referral service means that patients in prison can have access to the developments to which others in the community have access.
Baroness Finlay of Llandaff (CB)
My Lords, a quarter of a century ago, I worked with the then Minister for Prisons following the difficulty we had releasing a shackled remand prisoner. The recommendation was that every prison should have a link with a hospice service in their area to ensure appropriate care, particularly for prisoners who cannot be transferred out of prison and who may wish to die in their cell, with their cellmate providing some of the support for them as they are dying. Can the Minister tell us how many prisons actually have such links?
Baroness Merron (Lab)
I thank the noble Baroness for raising such an important point and for having worked on this in the past. I will need to write her with the exact figures, but we do know that more needs to be done to address health issues. However, we are keen to ensure, and are working towards making sure, that healthcare for prisoners, whether at the end of their lives or earlier, is appropriate and meets their needs, whichever is the right way to do it. Great strides have been made in that regard.
Baroness Manzoor (Con)
My Lords, the Minister will know that the most common diseases in prisons are diabetes, high blood pressure, HIV and mental illnesses. What are the Government doing to ensure that psychosis resulting from the use of illicit drugs is being controlled effectively, so that there are not more cases of psychosis and mental illness in our prisons?
Baroness Merron (Lab)
Substance misuse in prison, to which the noble Baroness refers, is of course a major issue, and prison security has a crucial role to play in reducing it. I should also say that the use of illegal drugs can impact on routine healthcare for all prisoners, as resources have to be directed to the more immediate cases. Noble Lords may remember that we recently had delegated legislation to ensure that nasal Naloxone could be administered, including by prison staff, to prevent opioid-induced emergencies. All these things will help, and substance misuse support is available in all prisons in line with the national service specifications, but we are working across government to see what more we can do. It is a big issue.
Baroness Burt of Solihull (LD)
My Lords, many of the issues preventing prisoners getting equivalence of care with non-prisoners clearly relate to access to hospitals and health specialists. As we know, delays can exacerbate conditions. Will the Government ensure that the Nuffield Trust recommendations on improving transparency, prisoner escort numbers, reviewing the supply of prison escorts and increasing access to out-patient services via telemedical services are implemented as fully as possible?
Baroness Merron (Lab)
The use of technology is hugely important in all areas, particularly in respect of prison services, as the noble Baroness says. There is a policy specifying that escorts must consist of at least two prison officers, with at least one being of the same gender as the prisoner unless there are exceptional circumstances. I take this opportunity to say that every effort is made to ensure that female staff support women, particularly where appointments are specifically related to services such as gynaecology. It is very important that we are aware of the possibility of retraumatising women prisoners, and we have been particularly mindful of that in relation to escorts.
Lord Kamall (Con)
I start by thanking the noble Baroness, Lady Morgan, for sending me a briefing in advance of this Question. She rightly and importantly highlights that cancer outcomes for prisoners are poorer than for the rest of the population, while the cost of services is greater. However, given that we will be debating the Mental Health Bill later today, I want to ask a related question. Over 30% of prisoners have a learning disability, so what steps are the Government, the NHS and the Prison Service taking to protect and care for prisoners with learning disabilities? They may be there partly as a result of their learning disability, and while in prison are often at their most vulnerable. What care is there for prisoners with learning difficulties in order to protect the public and reduce the risk of reoffending when they are released?
Baroness Merron (Lab)
As the noble Lord rightly says, the Mental Health Bill is in Committee this afternoon and I know we will refer to that. Certainly, the reforms in the Bill will speed up access to specialist in-patient care and treatment, in particular by introducing a statutory 28-day time limit for the transfer of patients from prison and other places of detention to hospital. On particular needs, which may be learning disability and autism, as I know noble Lords are aware, the Mental Health Bill is very focused on ensuring that people are being cared for in the right places in the right way, and that in places of detention people are being not just held but supported and their healthcare needs met.
The Lord Bishop of Gloucester
My Lords, women in prison have very specific health needs. Will the new women’s justice board look at ensuring that health and social care services across the women’s estate are consistently gender-specific and sensitive to women’s protected characteristics?
Baroness Merron (Lab)
I can give that assurance to the right reverend Prelate, and I certainly agree about the particular needs of women in prisons. It is perhaps helpful to tell your Lordships’ House that new women’s health and well-being hubs will begin in all 12 female prisons from 1 April.
Lord Woodley (Lab)
My Lords, it is very well known that IPP sentences have broken the mental health of hundreds of prisoners. Does the Minister agree that it is the responsibility of the state to help fix the damage caused by these torture sentences, and that greater resources are needed for medical treatment for and support of IPP prisoners?
Baroness Merron (Lab)
I know that the Ministry of Justice is also looking at this, and my noble friend is certainly right to make that point.
Sub-Saharan Africa: Diplomatic Relationships
(1 day, 11 hours ago)
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Lord Bruce of Bennachie
To ask His Majesty’s Government what are their main strategic objectives for developing closer diplomatic relationships with countries in sub-Saharan Africa, in terms of aid, trade, investment or cultural exchange.
The Parliamentary Under-Secretary of State, Foreign, Commonwealth and Development Office (Baroness Chapman of Darlington) (Lab)
My Lords, in line with our manifesto commitment, the Foreign Secretary launched a five-month consultation to inform the UK’s new approach to the African continent during his visit to Nigeria and South Africa in November. Our goal is fundamentally a transformed partnership that engages with African countries as equals. This will promote our economic growth ambitions, including trade and investment, address our migration priorities and draw on our shared cultural and people-to-people links.
Lord Bruce of Bennachie (LD)
While I welcome that Answer, the UK has disengaged drastically from Africa in the last few years—aid has been slashed, trade and investment have been halved, the investment summit was cancelled, and the World Service and the British Council are struggling to maintain their services. Russia and China have come exponentially into this vacuum, so what are the Government going to do specifically and practically across all sectors to engage with sub-Saharan Africa? Will they follow the example of Japan, China, India and the EU and set up a UK- Africa partnership?
Baroness Chapman of Darlington (Lab)
My Lords, I could not have put that better myself. It was a very helpful summary of where we are. On aid, we are committed to the 0.5%. We have an ambition to get back to where we ought to have been at 0.7%, but noble Lords will understand the inheritance we received—I do not need to mention the £22 billion black hole as my noble friend is here beside me.
The noble Lord is completely right to highlight the World Service and the British Council. He will notice the financial support we were able to provide the World Service in the recent Budget, and we are working closely with the British Council to make sure it is put on a stable footing because it is essential as one of the finest soft power assets this country possesses. He referred to Russia and China, and clearly it is for African nations to decide their own international partnerships, but many have expressed the view that they wish to work more closely with the United Kingdom and we are very open to that as part of our new approach.
Lord Howell of Guildford (Con)
My Lords, is it not a slight pity that so far in this exchange there has been no mention of the Commonwealth network? There are 22 Commonwealth countries south of the Sahara. They are the main bulwark against Chinese and Russian incursion. Is it not time for us to have a rather more central role for the Commonwealth in our thinking about Africa and to commit more seriously to Commonwealth countries, several of which now wish to join in addition to the existing 22? It is a growing organisation and we should support it vigorously.
Baroness Chapman of Darlington (Lab)
That was very well put. I could have mentioned the Commonwealth; it is a vital multinational grouping, as the noble Lord says. I work closely with many Caribbean nations where the Commonwealth is well represented, and that needs to form part of our thinking in the future. I thank him for raising it.
Lord Hannay of Chiswick (CB)
My Lords, does the Minister recognise that we need ambassadorial representation in as many African countries as possible—more than we have now? We should not be seduced by the idea of multiple accreditation, which frankly is not worth a lot, as I discovered during the Somalia and Rwanda crises in the 1990s, when we had nobody on the spot.
Baroness Chapman of Darlington (Lab)
I would be very wise to take what the noble Lord says seriously, and I do note it. At the moment we are engaged in a five-month consultation with African nations and others to inform what will be a new approach to Africa. The points that the noble Lord just made will be considered as part of that approach; I thank him.
Lord Anderson of Swansea (Lab)
Does my noble friend agree that in our engagement with sub-Saharan Africa we must try to understand the Africa gap and why the region is turning out so badly compared with east Asia, for example—a matter illustrated very well in the most recent edition of the Economist? We should try to encourage having more Africa specialists in our Diplomatic Service. We should also try to encourage the lowering of national barriers and co-operation with Africa and, as always, do our very best to encourage civil society in the region.
Baroness Chapman of Darlington (Lab)
I read the piece in the Economist and it was very useful. The approach that we are consulting on at the moment will touch on many of the issues raised by my noble friend. We want to see an approach that is more about partnership than paternalism, working alongside African nations. My noble friend Lord Collins is in Botswana today, and I know that is precisely the approach that he wishes to take.
Lord Ahmad of Wimbledon (Con)
My Lords, what assessment have His Majesty’s Government made of the growing influence of the BRICS grouping, in particular its economic influence? There are also the issues of security and cyber, which will impact sub-Saharan Africa as well as other parts of the world. BRICS is a growing grouping, and we saw its direct contest with the Commonwealth during the recent CHOGM held in the Pacific.
Baroness Chapman of Darlington (Lab)
We do not think of it as a contest. That was just a diary coincidence, if I can put it that way. It is not for us to tell African nations or anybody else which groupings they should align with, but we find that there is a desire—a genuine desire, I think—to work more closely with the United Kingdom. Sometimes we have perhaps not put the energy that we might into that; sometimes we have perhaps made it too difficult compared with attracting investment from other nations. We want to consider and do all these things as well as we can, as we get to the end of our consultation on the new approach.
Lord Purvis of Tweed (LD)
Further to the Minister’s reply to my noble friend on partnership assistance levels, is it not correct that, as a result of this Government’s Budget, ODA is now at the lowest level for 17 years? Also, one of the unforgivable actions of the previous Administration was to score more ODA spending in the United Kingdom than in sub-Saharan Africa, or indeed anywhere abroad. This is a policy choice, not a fiscal choice, and the Government have so far chosen to adopt the previous Conservative Government’s approach. Will the Minister agree with me that the way to restore trust with those countries with the greatest need and poverty is to ensure that ODA is not only official development assistance but overseas development assistance and is not scored for spending here in the UK?
Baroness Chapman of Darlington (Lab)
I do not want to spend ODA here in the UK. That money is being spent on housing people who have come here in hotels, and it is costing a fortune to do so. That money ought to be spent on education and humanitarian assistance in countries where it is needed the most. That is how this should be, and that is the situation that the FCDO and the Home Office are working hard to get to. We have committed so far to the 0.5%. What 0.5% equals depends entirely on the size of the economy and, as the economy grows, that 0.5% will be worth an awful lot more. As I said earlier, we want to get to back to 0.7% spend, which we never should have left.
The Earl of Courtown (Con)
My Lords, notwithstanding what the Minister has said concerning His Majesty’s Government’s aims and ambitions in sub-Saharan Africa, how are they ensuring that their foreign aid there delivers measurable outcomes and aligns with the Government’s priorities, such as supporting good governance, supporting economic development and tackling corruption?
Baroness Chapman of Darlington (Lab)
The Foreign Secretary’s priorities for this are around growth, security, government and climate. These are things that we are working hard on through our engagement not just with sub-Saharan Africa but in Asia, Latin America and elsewhere. The noble Earl is absolutely right that every penny we spend on official development assistance must be the very best value for money that we can secure—yes, because of fairness to the UK taxpayer, but also because a bad programme funded by ODA means that a good programme somewhere else does not get to take place. The Foreign Secretary is very keen that we make sure that happens. He is reviewing our spend and the effectiveness of programmes, and he is right to do that.
Lord Grayling (Con)
My Lords, I declare an interest as a trustee of the African Wildlife Foundation. I ask the Minister to look carefully at how we spend our aid money. So much of it goes through international or regional bodies and, often, when the money gets to practical solutions on the ground, the UK is not visible as a donor. That weakens our soft power, so can the Minister look at the different ways in which we spend aid money to make sure that our soft power really is visible on the ground?
Baroness Chapman of Darlington (Lab)
I think it was Tony Blair who said that our international development spend is the strongest soft power asset that we have. He had a point. We work multilaterally because that is often the most effective way to get the best value for money. I take what the noble Lord says about that sometimes meaning that we do not get all the credit, but sometimes it is important to prioritise getting the aid to where it is needed most, which needs to be our first concern. I will consider what he says, but this is all about making sure that we get the biggest impact for every penny we spend.
Listed Historic Buildings
(1 day, 11 hours ago)
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The Lord Bishop of St Albans
To ask His Majesty’s Government, following Historic England’s publication of the latest Heritage at Risk Register, what plans they have to ensure adequate support for listed historic buildings.
The Parliamentary Under-Secretary of State, Department for Culture, Media and Sport (Baroness Twycross) (Lab)
The Government are committed to protecting the historic environment for the benefit of present and future generations. DCMS and its arm’s-length bodies deliver funding to the heritage sector, including £8 million last year to rescue buildings on the Heritage at Risk Register. In 2024, 124 historic places from the register were saved, bringing treasured heritage assets back to life. Some 150 buildings were added, which highlights the need for continued support for our most vulnerable heritage.
The Lord Bishop of St Albans
My Lords, the Listed Places of Worship Grant Scheme comes to an end in April. It represents a group of buildings that host hundreds of thousands of weddings, baptisms and funerals, right at the heart of their communities—and 80% of those buildings host some 31,000 social action projects, such as warm spaces and food banks. Will the Minister ask her ministerial colleagues whether they would be prepared to answer the correspondence from the Church of England on the future of this scheme? Would she personally be willing to meet my right reverend friend the Bishop of Bristol and her team to discuss this as a matter of urgency?
Baroness Twycross (Lab)
I would be very happy to meet the right reverend Prelate’s colleague, the right reverend Prelate the Bishop of Bristol. The Government are very clear that the Listed Places of Worship Grant Scheme has been incredibly valuable in assisting more than 13,000 listed places of worship to recover VAT or repairs through the grants, totalling over £317 million since it was established more than 20 years ago.
On the outcome of any discussions about the future of the project, departmental budgets have been set following the Budget announcement in the autumn, and the outcome of the departmental business planning process, including any implications for this scheme, will be announced soon. However, I shall follow up the letter referred to in the right reverend Prelate’s question.
Lord Swire (Con)
My Lords, much of our built heritage up and down the country is literally crumbling, and the backlog of repairs is getting longer and longer. That is in no small part due to the different rates of VAT. When we were part of the EU, we were always told that we could not vary the rate of VAT on restoration, as opposed to new build—but we are not in the EU anymore, and we can set VAT at whatever level we like. Will the Government look, as a matter of urgency, at having parity between restoration and new build, or at least look again at trying to reduce the costs of restoration for our built heritage, which is among our greatest national assets?
Baroness Twycross (Lab)
Decisions on tax policy are for the Chancellor, which are made in the context of the overall public finances. The noble Lord will note that my noble friend Lord Livermore is here, so I am fairly confident that he heard the point that the noble Lord made very clearly.
Lord Redesdale (LD)
The right reverend Prelate raised the social good done by listed places of worship, of which half churches are listed—including, of course, the majority of all food banks that take place at those premises. Is the Treasury looking at understanding through the Red Book the value to the NHS of the work being done by those churches? Without that work, a lot of the issues will fall on the NHS, which would cost a great deal more than the grants being offered.
Baroness Twycross (Lab)
I understand that my noble friend Lord Livermore would be happy to look into that point.
The Earl of Devon (CB)
My Lords, I note my interest as steward of listed buildings in Devon, one of which was recently removed from the Heritage at Risk Register, courtesy of works funded by Natural England’s Countryside Stewardship scheme. Given the continued disaster that is the restoration and renewal programme, do the Government know how long it will be before the Palace of Westminster is added to the register?
Baroness Twycross (Lab)
My noble friend the Leader of the House has noted the issues with the heating. I will not comment on the heating, but it is quite warm in the Chamber today—so that at least is positive.
The restoration and renewal programme is a matter for Parliament. I understand that a debate is coming up very soon on this issue, which I encourage noble Lords with a particular interest to take part in. I cannot comment on whether the Palace will be added to the Heritage at Risk Register, but clearly there has been lots of discussion about the issues facing what is an invaluable building for parliamentarians but which is also of historic and cultural value to the country.
Baroness Andrews (Lab)
My Lords, does the Minister agree—I am sure she does—that the historic environment is an enormous social and economic asset to this country? Sometimes we overlook it because we are so familiar with it, but it is particularly important in social regeneration, no matter the community, which is why it was part of the previous Government’s levelling- up programme. How will our Government optimise all the benefits that the historic environment can bring, particularly in the context of the growth agenda?
Baroness Twycross (Lab)
I am very happy to agree with my noble friend about the value of heritage. Indeed, in preparing for this Question I read a fascinating list of properties, buildings and even high streets—including one I lived very close to until quite recently—that have benefited from investment and restoration. This benefits local communities and contributes to economic growth and preserving heritage for present and future generations.
The Earl of Effingham (Con)
My Lords, I believe that every one of us has the incredible privilege to work in this listed historic building, but there are 4,891 listed buildings on the Heritage at Risk Register. Does the Minister agree that there really should be a successor scheme to the one she just referenced: Historic England’s high streets heritage action zones programme, which ran from 2020 to 2024? It unlocked the potential of 67 historic high streets, created social cohesion and drove economic growth, which is precisely what the Government want. Will she please commit to a successor scheme?
Baroness Twycross (Lab)
That programme is a fantastic example of the value of heritage as an investment in our communities. As someone who felt very strongly that the South Norwood area, which is where I previously lived, could really benefit from this sort of investment, I absolutely recognise its value. The noble Earl will be aware that the initial £95 million of public investment unlocked more than £140 million of further private and public investment. On future commitments, as previously referenced, we are going through the business planning process, so any future funding for individual programmes is currently being assessed and will be announced soon.
Lord Wigley (PC)
My Lords, will the noble Baroness tell the House, if she has the information, how many of the sites on the Heritage at Risk Register are world heritage sites, and how many of those are therefore in danger of losing their world heritage status? What steps will the Government take on that? I draw attention to my interest, being involved in world heritage partnerships across the UK.
Baroness Twycross (Lab)
That is a very interesting question. It is not one that I have the answer to, but I will write to the noble Lord to ensure that that information is available and place a copy of the letter in the Library.
Lord Mackinlay of Richborough (Con)
My Lords, I refer the House to my interests in the register. I was also the chairman of the All-Party Group on Listed Properties for many years, a body that I wish to get back up and running again, I hope with support in this House. I also live in a listed property. I share the right reverend Prelate’s concerns in relation to the Listed Places of Worship Grant Scheme and the concerns about VAT. For many years up to 2012, a lower rate or a zero rate of VAT applied for properly approved listed property works. That was removed by a Conservative Government, but that does not mean that it was the right thing to do. In the face of the high cost for listed property owners of specialist builders and specialist materials, getting planning consent can add dramatically to the cost. There is also the issue of insurance premium tax. Listed property owners face far in excess of the usual increases in insurance because the market is restricted. It is not fair that the Treasury is enriched through insurance premium tax on top of that. Could that be looked at please?
Baroness Twycross (Lab)
I hear the noble Lord’s concerns. From a government perspective, we would be very keen to understand how this would be funded, given the overall economic situation we find ourselves in. If he has any suggestions on that point, I would be very happy to hear them.
Sterling: Rise in Yields on 30-year Gilts
(1 day, 11 hours ago)
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Baroness Neville-Rolfe
To ask His Majesty’s Government what assessment they have made of the impact of the rise in the yields on 30-year gilts to 5.37 per cent, the highest level since 1998, and the effect of this on sterling.
The Financial Secretary to the Treasury (Lord Livermore) (Lab)
My Lords, the Government do not comment on specific financial market movements. Gilt yields are determined by a wide range of international and domestic factors and it is normal for the price and yields of gilts to vary when there are wider movements in global financial markets. The Government are committed to economic stability and sound public finances. Meeting the fiscal rules is non-negotiable and growth is our number one mission.
Baroness Neville-Rolfe (Con)
My Lords, the annual cost of servicing the national debt is now over £100 billion and is estimated to have grown by £12 billion since the Budget. Gilt yields have leaped up, with the critical 10-year rate now at 4.88%—the highest since 2008. The Government need to grasp the seriousness of the situation and the concern that the OBR report is more than two months away. Their own fiscal rules are in jeopardy. Which of their commitments do they propose to break—not cutting expenditure or not raising taxes? Can the Minister rule out an emergency Budget?
Lord Livermore (Lab)
As the noble Baroness knows, financial markets are always evolving so it is a long-standing convention that the Government do not comment on specific financial market movements. She will also know that the Chancellor has commissioned the Office for Budget Responsibility to carry out an updated economic and fiscal forecast for 26 March, which will incorporate the latest data. Only the OBR’s forecast can accurately predict the effect on the public finances of any changes in financial markets or the economy, and I will not pre-empt it. However, there should be absolutely no doubt of our commitment to economic stability and sound public finances. That is why meeting the fiscal rules is non-negotiable.
Baroness Kramer (LD)
My Lords, the issue is one of confidence in the British economy. Today, Shevaun Haviland, director-general of the British Chambers of Commerce, called again for quick action to speed up the business rates review, green-light infrastructure projects and build trade, especially with the EU. Do the Government recognise that that kind of leadership and tangible near-term action, rather than long-grass proposals, will give confidence back to the UK economy? Will they take up that challenge for near-term action?
Lord Livermore (Lab)
We absolutely will. I completely agree with the noble Baroness. I met Shevaun Haviland last Thursday and we had a very constructive conversation about the measures that the British Chambers of Commerce wants to see to grow the UK economy, which are exactly the same measures that we want to see. The noble Baroness is absolutely right that growth was one of the biggest failures of the previous Government. We are determined to turn that around, which is why we are going further and faster. We are reforming planning, pensions and skills, all of which will significantly boost growth in the UK economy.
Lord Eatwell (Lab)
My Lords, the House will be aware that this country has an outstanding Chancellor of the Exchequer at the moment. However, will the Minister enlighten me as to what influence she really has on the US treasury bill market, which has shown the same spike as in the UK, or on the market for the euro, which has fallen against the dollar to the same extent as has the pound? Is it not the case that questions from the Opposition Front Bench might have more economic relevance if they reflected some understanding of how global markets actually work?
Lord Livermore (Lab)
My noble friend is absolutely right and I echo his comments about the Chancellor of the Exchequer. There are limits to what she can do, but she is absolutely able to focus on the priorities of this Government. As noble Lords will know, this Government inherited a £22 billion black hole in the public finances left by the previous Government. She has taken very difficult decisions to deal with it, every single one of which has been opposed by the party opposite. However, they were the right decisions because we had to repair the public finances and ensure fiscal responsibility. She has set extremely tough fiscal rules—tougher than those of previous Governments—again, opposed by the party opposite. Meeting those fiscal rules is non-negotiable because we will not compromise on economic stability.
Lord Morse (CB)
My Lords, does the Minister recognise that the current rise in gilt prices, viewed alongside the market reaction to Liz Truss’s mini-Budget, shows that current market confidence in the UK can be fairly described as fragile? Does he also agree that any Government, of whatever political stripe, is likely to sow the wind and reap the whirlwind if they implement policies that ignore business confidence and stability?
Lord Livermore (Lab)
The noble Lord will be aware that financial markets are always evolving. It is a long-standing convention that the Government do not comment on specific financial market movements. He mentioned the Liz Truss mini-Budget, which crashed the economy. Current conditions are very different from then, when long-dated bonds were most significantly impacted due to market dysfunction. That market dysfunction was caused by unfunded tax cuts, unrealistic spending plans and undermining the institutions that are crucial to economic stability: the Treasury, the OBR and the Bank of England. It pushed up mortgage costs by £300 a month, for which working people are still paying the price. Yet there is still no apology from the party opposite, which, instead, tries to defend it.
Earl Attlee (Con)
My Lords, when will the Government’s planning reforms positively affect the UK economy?
Lord Livermore (Lab)
They already are. We have seen many planning projects already unblocked by this Government as a result of changes to planning. As soon as this House passes the planning Bill, we will see even more growth in the UK economy.
Lord Sikka (Lab)
My Lords, during the 14 years of the last Government, public debt increased from £1 trillion to £2.8 trillion. Public services were decimated, NHS waiting lists tripled, average real wages fell back to the 2008 level and 16 million people now live below the poverty line. Does the Minister agree that the Conservative Party owes the country an explanation?
Lord Livermore (Lab)
I agree that the Conservative Party owes the country an explanation—it also owes the country an apology. There was no bigger failure of the previous Government than their failure on growth. First, they introduced austerity, which choked off investment. Then, their Brexit deal created new trade barriers equivalent to a 13% increase in tariffs for our manufacturing sector, permanently reducing GDP by 4%. Finally, their disastrous mini-Budget crashed the economy and set inflation and interest rates soaring. Of course, they left us with the £22 billion black hole in the public finances.
Baroness Redfern (Con)
My Lords, after this Government inherited the second-lowest debt in the G7, we now see business confidence ever diminishing—and the public, too, are rightly concerned. We are also witnessing gilt levels at a 30-year high. Does the Minister agree that the gilt markets are in turmoil and therefore technically not functioning in an ordinary way? Does he stand by his Chancellor, who said that there will be no further tax rises?
Lord Livermore (Lab)
If I may, I will correct the noble Baroness: UK gilt markets continue to function in an orderly way. Underlying demand for the UK’s debt remains strong, with a generally well-diversified investor base. The Debt Management Office’s gilt sales operations continue to see strong demand, with the latest auction, held earlier today, receiving three times as many bids as the amount on offer. The noble Baroness mentioned what we inherited, so she will be very aware that we inherited a £22 billion black hole in the public finances. We have taken very difficult decisions to deal with that, every single one of which has been opposed by her party.
Viscount Thurso (LD)
My Lords, what consideration have the Government given to the Bank of England’s current policy of fairly aggressive quantitative tightening? Do they feel that this is helpful in the current market? Should the Chancellor consider issuing a direction to the Bank on this issue?
Lord Livermore (Lab)
The Government support the Bank of England in the actions that it takes.
Baroness Lister of Burtersett (Lab)
My Lords, there has been worrying talk about cuts to the social security budget. Following my noble friend Lord Sikka, I ask: will the Government consider the fact that previous Governments, over the last decade, cut £50 billion a year from the social security budget, according to the Child Poverty Action Group, and that poverty is much deeper as a result? Please will this be taken into account before any consideration is given to further cuts to social security?
Lord Livermore (Lab)
I completely agree with my noble friend that poverty is an absolute priority for this Government, as it should be, but so too is getting people back to work, and welfare reform is necessary to do that.
Great British Energy Bill
(1 day, 11 hours ago)
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Lord Hunt of Kings Heath
That the Bill be reported from the Committee of the Whole House in respect of proceedings up to and including 13 January; and that the order of commitment of 18 November 2024 be discharged and the remainder of the Bill be committed to a Grand Committee.
The Minister of State, Department for Energy Security and Net Zero (Lord Hunt of Kings Heath) (Lab)
My Lords, I think it would be helpful to the House if I explain this Motion and, for those noble Lords who were not in your Lordships’ House at 10 pm last night, the circumstances that give rise to it.
The Great British Energy Bill is an eight-clause Bill that provides a statutory basis for Great British Energy as a publicly owned company to become operationally independent and start delivering benefits for the UK. This includes driving clean energy deployment and boosting energy independence so we can enjoy the benefits of clean, secure, homegrown energy. It was in the Government’s manifesto, it was one of the first Bills to be introduced following the general election and it has been through all its Commons stages.
The Bill was initially scheduled for two days of Committee of the whole House. Progress in Committee has been, shall we say, somewhat slow. In total, 153 amendments have been tabled, which is around 19 amendments for every clause of the Bill. Last night, it was the Government’s intent to finish Committee, but at five minutes past 10 the Opposition Chief Whip moved the adjournment of the House, which was successful.
Report has been agreed for 11 February. Noble Lords will have noted that, over the next two weeks, the House will be heavily engaged in this Chamber with the Mental Health Bill and Martyn’s law. So, noting the request from the Official Opposition for more time to scrutinise the Bill, my noble friend the Chief Whip has kindly arranged for it to be considered in Grand Committee on Wednesday 15 January and 22 January if required, and noble Lords will be able to table further amendments today. If the Motion is agreed to, the groupings will be circulated to those who have tabled amendments as soon as possible, with a deadline for changes at 8 pm. I hope this will allow further debate on the Bill, which indeed is what the Official Opposition requested, and I very much hope that the whole House will support the Motion. I beg to move.
Baroness Williams of Trafford (Con)
My Lords, last night this House voted to adjourn the House at a conventional time of 10 pm to stop the Government rushing through the Great British Energy Bill—on which the Government intend to spend £8.3 billion of taxpayers’ money. Today, after two and a half days of scrutiny in this Chamber, the Government are seeking to finish the Bill away from the Floor of your Lordships’ House in Grand Committee. As far as I recall, where the Official Opposition object, this is quite an unprecedented move. Before we adjourned last night, we completed nine groups and started a 10th. In all the years that I was a Minister, I would have been delighted to have completed and made so much progress on a Bill in a day. Ten groups is not a filibuster; it is reasonable progress in anybody’s books.
I note the Government’s new habit of labelling groups “degrouped” despite us providing reasoned titles for them. So, for the benefit of the House, I will very briefly run through the groups that we debated yesterday, and then perhaps the Minister, if he wishes, can tell us which of these did not deserve to be debated: directions to GB Energy on consumer energy bills, new jobs, developing supply chains, the cost of fulfilling strategic priorities, national grid infrastructure, carbon emissions, imported energy, UK manufacturers and financial returns; the impact of GB Energy investments on electricity prices, returns, employment and the environment; consultation and oversight; the inappropriate use of prime agricultural land; a large miscellaneous group—actually intended to be helpful to the Government—which included mandatory reinvestment of profits, exclusion of investments to projects with government subsidies, independent evaluation of investments, limitation of investments to UK-registered companies, limitations on money spent on travel to conferences, and support for companies and universities; nuclear energy; curtailment of renewable energy; energy storage; renewable energy generation; and reporting, accounts and auditing.
Which of those topics did not deserve fair and proper scrutiny? Energy security, energy storage and the environment? Just this weekend, we have read reports of the Chancellor of the Exchequer negotiating closer ties with China and of fuel reserves reaching critical lows in the very cold spell. It is very important and topical business. If there is a group of amendments that did not deserve to be debated, I should be very grateful to be enlightened.
Every noble Lord in this House has a right to be heard, and yesterday we heard from Members with widespread experience and expertise. I challenge any noble Lord to read back through Hansard and find me one speech that they consider inappropriate. All of them were informed and insightful, and within the advisory speaking times set out in the Companion.
The job of the Opposition is to scrutinise the work of the Government and hold the Government to account. This is nothing personal; it is simply the proper functioning of our Parliament. When the tables were turned and it was the Labour Party occupying these Benches, we had 13 Bills which took more than 10 days in Committee. The Parliamentary Voting System and Constituencies Act 2011 and the Welfare Reform Act 2012 took 17 days, and the Health and Social Care Act 2012 and the Levelling-up and Regeneration Act 2023 each took 15 days. We debated thousands upon thousands of amendments. I was often the Minister on those Bills. Since 2015, the most amendments tabled to a Bill has been 1,249, but there have been 51 Bills which had more than 200 amendments tabled to them, 23 Bills that had more than 400 and 16 that had more than 500.
We will not be voting against this Motion today. We made our point last night, and I had hoped that the Government might listen. I reiterate that we simply seek to subject legislation to the fullest and most appropriate scrutiny, as is our responsibly.
Lord Hunt of Kings Heath (Lab)
My Lords, I am most grateful to the noble Baroness for not opposing the Motion that I intend to press in a moment. Of course I recognise that it is the role of the Opposition to scrutinise legislation. I would say that Grand Committee offers an opportunity for effective scrutiny, and I have no doubt that, in the two days reserved, we will see many more contributions from noble Lords—no doubt repeating the points that they have made time and time again on this Bill.
I just say to the noble Baroness that, in relation to the groups of amendments that we debated last night on directions, it is interesting that when, at the beginning of Committee and at Second Reading, noble Lords opposite seemed to accuse the Government of wishing to use the Clause 6 directions to micromanage the company, we made it abundantly clear that it is a backstop reserve which we hope will never have to be used. Noble Lords opposite then simply used the direction clause to act to come forward with a series of amendments. Many of the issues had already been debated in the first five clauses, and there was a vigorous degrouping to ensure that we had many repetitive contributions. I have been a Member of your Lordships’ House for 27 years. I recognise a filibuster when I see it. Last night was a filibuster.
Gas Storage Levels
(1 day, 11 hours ago)
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Lord Offord of Garvel (Con)
My Lords, last week, Centrica commented on Britain’s storage levels as being “concerningly low”. We know that the UK’s gas supply is pretty tiny in comparison to the rest of Europe, but the Government’s position seems to be that there is no problem and no threat to our gas supply because we can simply import LNG to bridge the gap. The industry is saying that, looking forward to 2030, up to 80% of our gas will come from costly imports. Surely we should be supporting our own oil and gas industry in Britain, rather than shutting it down in favour of imports from abroad.
The Minister of State, Department for Energy Security and Net Zero (Lord Hunt of Kings Heath) (Lab)
My Lords, I am grateful to the noble Lord for his question. First, I must remind the House that, on Friday, National Gas confirmed that:
“The overall picture across Great Britain’s eight main gas storage sites remains healthy”.
The diversity of Great Britain’s sources of gas supply means that we are less reliant on natural gas storage than our European counterparts. This includes, as the noble Lord suggests, supplies from the UK continental shelf; our long-term energy partner, Norway; international markets via liquefied natural gas; and interconnectors to the European continent.
I understand and fully accept what the noble Lord says about the North Sea and the contribution of the oil and gas sector, which we have debated, but it is essential that we move as quickly as possible to clean power. Clearly, by 2030, that will give us a great advantage in energy security. We will look for low-carbon, flexible technologies to ensure that we have the proper balance when we get to clean power. We want to see a successful transition in the North Sea, recognising the contribution that it makes and will continue to make.
Earl Russell (LD)
My Lords, does the Minister agree, first, that this is a fabricated scare story? There are no issues with our gas. It is not running out and it can be quickly resupplied via pipelines and LNG. Secondly, does he agree that the best resolution is the rapid end to the Conservative’s legacy of overdependence on very expensive imported foreign energy? To that end, the Conservatives would be well advised to stop filibustering on the Great British Energy Bill, which will greatly improve our energy security, decrease our overdependence on expensive imported foreign gas from tyrants such as Putin, bring down energy bills and costs for bill payers, and help us to meet our energy and climate targets.
Lord Hunt of Kings Heath (Lab)
My Lords, I am glad that I was not alone in thinking that we enjoyed a filibuster last night. What is tragic is that the Conservative Party is clearly retreating from net zero and clean power and has become obsessed with gas. This is not the way that we need to go. The noble Earl is quite right. Centrica chose to put out what I can only describe as an alarmist statement. NESO and British Gas are quite clear that we did not face a crisis and that we have adequate supplies. I hope that those who were involved in making those claims last week will reflect on the concern that they caused.
Lord Reid of Cardowan (Lab)
My Lords, I welcome the Minister’s Statement. For the clarity of the house, can he confirm that the statement put out last week by NESO was a completely normal, conventional, operational statement which is made regularly to ensure that we have one of the safest and most reliable systems in the world?
Lord Hunt of Kings Heath (Lab)
That is right. NESO manages this with an operating margin, made up of the operating reserve—1,400 megawatts, which it always keeps in reserve. There is a contingency reserve of an additional 800 megawatts on top of that operating reserve. That contingency reserve was tight last week and so an electricity margin notice was issued, as my noble friend suggested. This is a perfectly normal market response to a tightening of the situation, which was resolved immediately.
Baroness Hayman (CB)
My Lords, I declare my interest as chair of Peers for the Planet. The Minister’s Statement and his reply to the noble Lord just now are reassuring, as was all the independent analysis of what happened last week. We were not in a crisis. Nevertheless, it is important that, as we move towards more dependence on renewables, we look at the issues of long-duration energy storage and energy efficiency. We do not have a long time until 2030. Can the Minister tell us when we will be able to put some real targets on the amount of long-duration energy storage, which the Science and Technology Committee of this House says that we need urgently?
Lord Hunt of Kings Heath (Lab)
My Lords, I was present during the debate on Thursday on the Select Committee’s excellent report on this very subject. I refer my friend the noble Baroness to the action plan that my department issued only a few weeks ago, estimating that between 40 gigawatts and 50 gigawatts of dispatchable and long-duration flexible capacity could be needed by 2030. We are going to take a number of interventions to ensure that this happens. We have already announced a ground-breaking deal with Net Zero Teesside, our first power CCUS project. We are developing a hydrogen-to-power business model to derisk investment in that area. Ofgem will be introducing the cap and floor scheme to support investment in long-term duration electricity storage. We aim to open the scheme to applications in quarter 2 of 2025. We fully take on board the point that the noble Baroness makes and the Select Committee report.
Lord Lennie (Lab)
My Lords, what was the level of storage at the Rough facility when Labour last left office in 2010 and what happened to that storage facility after the Tories took power?
Lord Hunt of Kings Heath (Lab)
My Lords, Rough was closed in 2017. At that time, when the party opposite was in government, I do not think that it raised any concerns at all. Indeed, the then Energy Minister, the noble Lord, Lord Harrington, said that the closure of Rough would not cause a problem with security. In 2022, Centrica decided to re-open the site. This was a commercial decision by the company. It now seeks government support. One needs to draw a line between the announcement that it made last week and its request for government support.
Baroness Hoey (Non-Afl)
My Lords, many people in the public will still not understand the logic of why we spend some £14 billion buying gas from Norway from the same North Sea that we ourselves could be taking it from. Does the noble Lord think that Norway cares any less about the environment and net zero than we do?
Lord Hunt of Kings Heath (Lab)
For a very long time, we have taken supplies from Norway. It is surely a great advantage of our system that we can look to a diversity of supply. The North Sea supply has been declining over many years now; if it were not in that situation we could, where we needed gas in the future, just look there, but that is not the position. That is why we are trying to manage a transition which recognises that the North Sea still has a contribution to make. The essential point here is that we move as quickly as possible to clean power. That is the best way to get to homegrown energy, which I think the noble Baroness is really pointing to.
Baroness Sheehan (LD)
I wonder if I can move on to the need for warm homes. Heat pumps are very efficient in heating homes—every kilowatt of electricity generates three to four kilowatts of heat—yet cheaper electricity from renewables ends up being a more expensive option to heat homes than gas because the price of electricity is tied to the high price of gas. Does the Minister agree that this situation is nonsensical and that electricity prices must be decoupled from the price of gas?
Lord Hunt of Kings Heath (Lab)
That is a very wide question, and it is of course a matter that we should always keep under review. It is a situation that has existed for some time and which we inherited from the previous Government. On the substantive point, the noble Baroness is right about heat pumps and home insulation. We clearly need to make great progress on that.
Sudan: US Determination of Genocide
(1 day, 11 hours ago)
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Lord Callanan (Con)
My Lords, the news that our close allies in the US have assessed the situation in Sudan as genocide is, of course, deeply worrying. It underscores the terrible humanitarian situation going on there, something that we have debated extensively in this Chamber. Does the Minister agree that what is going on in Sudan is genocide? Does she agree with the Americans or with her ministerial colleague in the other place who said that this was a matter
“for the courts to decide”?”.—[Official Report, Commons, 13/1/25; col. 36.]
What assessment have the Government made of the potential security and geopolitical implications of this ongoing—I will call it what it is—genocide in Sudan for the UK and its allies?
The Parliamentary Under-Secretary of State, Foreign, Commonwealth and Development Office (Baroness Chapman of Darlington) (Lab)
My Lords, what is happening in Sudan is abhorrent, and we should all condemn it in the strongest possible terms. When it comes to genocide, the noble Lord opposite will be aware that we take a different approach to making these determinations from that of our close allies and friends in the United States.
I am surprised at the way in which the noble Lord put his point to me. Much as we agree on the substance of what is happening in Sudan and wish to see it end, I am surprised at what he said because it contradicts what his noble friend the shadow Foreign Secretary, Priti Patel, said in the House of Commons just yesterday. She said that she understood very well that we take a different approach to the determination of genocide from that of our colleagues in the United States, and that is an approach that she supported in government and still supports in opposition.
I hope that, much as we can perhaps differ—and the noble Lord can take this up with his noble friend in the Commons should he wish—the important thing is that we use every tool we can, diplomatically and using our multilateral and bilateral connections and our humanitarian work on the ground, to make sure that we do everything possible to bring an end to this unbearable suffering being endured by the people of Sudan.
Lord Purvis of Tweed (LD)
My Lords, I declare an interest as I have ongoing work with Sudanese civilians in exile. At the weekend, I will be travelling to be with them and to facilitate dialogue. Does the Minister agree that, however it is termed, these are war crimes and atrocities, and there should be no impunity for those who have carried them out? It is now potentially 12 weeks from what would be the second anniversary of this terrible war, but there should not be a second anniversary, and that should focus everybody’s minds on there being an end and resolution to the war.
How are the UK Government supporting practical measures to ensure that there are safe zones, especially for education and health facilities; no-fly zones, especially for drones—including those that have been supplied by Iran and other countries; and no blockages of humanitarian and food aid? Countries in the Gulf and near neighbours should now cease the funding and provision of weapons to belligerents. All this now needs to take place to ensure an end to this war. I hope the Government are being very active, notwithstanding the previous Russian veto, to ensure that there is no second anniversary to this war.
Baroness Chapman of Darlington (Lab)
Nothing proves more sharply that the Russians care nothing for the lives of Africans than their terrible decision to vote as they did at the UN. As the noble Lord said, there must be no impunity here. That is why we are supporting fact-finding missions and evidence-gathering activity on the ground in Sudan. Whether or not determinations of genocide are made at a court in the future, it will need that evidence to enable it to make a sound decision. That has been the Government’s focus.
The noble Lord talked about other countries and their activities. All I can say is that any countries with any influence of any kind, or any relationship with any side—this is a multi-sided conflict now—must use that for one purpose only. That is to de-escalate, to bring those parties to the negotiating table and to get that humanitarian support which, as the noble Lord said, is urgently needed by those communities now.
The Lord Bishop of Leeds
My Lords, that being the case, what pressure can the UK and the United States Governments put on the United Arab Emirates, which has been supplying and continue to supply funding and weapons to the RSF?
Baroness Chapman of Darlington (Lab)
The best thing I can do is to repeat what I have already said: the most important thing is to get those parties around the negotiating table and get that humanitarian aid where it is needed. Anybody or any state, with any influence over any party, must use that influence for good and to bring this conflict to an end as soon as possible.
Lord Alton of Liverpool (CB)
My Lords, there is no disagreement in the House about the importance of dealing with all atrocity crimes. In the previous Parliament, the noble Baroness’s party kindly supported amendments from the Front Bench to enable the High Court of England and Wales to determine whether a genocide is being committed. She touched on the problem of the International Criminal Court and the use of vetoes by countries such as China and Sudan never to allow these issues to get to the ICC.
Will the noble Baroness go back and look at the way that we determine genocides? Will she accept that, as long as 20 years ago, the ICC announced a genocide in Darfur? Some 2 million people were displaced and 300,000 people died; and 18 months ago, the All-Party Parliamentary Group on Sudan and South Sudan, in an inquiry that I chaired, warned that signs of genocide were emerging again. Under the 1948 convention, we have a duty to predict, prevent, protect and punish. The truth is that we are not doing any of them.
Baroness Chapman of Darlington (Lab)
My Lords, I remember the events of 20 years ago very well. I remember Colin Powell saying that it was genocide and being astonished by the continuation of atrocities, given that declaration. It is why our focus should not be on whether we use a particular term—that will come and words are important—as that determination must be made by a competent court in possession of the relevant evidence. Quite how that is done and which courts are deemed competent is an interesting question, and one that I am happy to take away. I think that we should re-examine that.
I am very glad that this has come before the House, because one of the things that has concerned me is that the famine taking place in Sudan is causing the death of more people than in Mali, Afghanistan, Bangladesh and Gaza put together, and it is receiving far too little attention from the world.
Lord Reid of Cardowan (Lab)
My Lords, I entirely agree with the sentiments and comments of the noble Lord, Lord Purvis. Whatever this is called, it is horrendous. Can my noble friend the Minister say a little more about what efforts have been made to achieve a political solution? Does she retain any hope in the Jeddah process?
Baroness Chapman of Darlington (Lab)
Hope is an interesting concept when it comes to Sudan. All parties seem to have breached the commitments they made as part of the Jeddah process. We remain the penholder at the Security Council. To give up hope is to give up on every effort we need to make to move things forward, so giving up on hope is not an option. It does not help anybody to be optimistic when there is little reason for optimism, but we will continue to pursue our calls for a negotiated outcome, a cessation of all violence and atrocities, and the aid to get to where it is needed.
Sometimes we will work directly and sometimes through multilateral partners. This has to end—so many people, and so many children, are dying. The sexual violence being experienced by women and children in Sudan is completely intolerable. We all have a responsibility to do what we can to highlight what is happening and do something about it.
Baroness Foster of Aghadrumsee (Non-Afl)
My Lords, as with all these things, there is much high politics, but meanwhile over 90% of children are not receiving schooling, as the Minister for Development in the other place pointed out yesterday. Can the Minister tell us some practical ways in which we can help those children to get the education they so desperately need?
Baroness Chapman of Darlington (Lab)
That is a really important point. Last summer my right honourable friend the Minister for Development, Anneliese Dodds, visited South Sudan on one of her first visits after her appointment. She got as close to the border as she could. She met many of the women and children who had been forced to flee and who had experienced the most awful violence. She has managed to secure a doubling of our aid to Sudan—it is now around £113 million—and that is for food, healthcare and, importantly, education, to make sure that those young people are educated as close to their homes as possible, because to miss out on that education just compounds the terrible circumstances in which they have found themselves.
Mental Health Bill [HL]
(1 day, 11 hours ago)
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Baroness Tyler of Enfield
“Equity | addressing inequalities in treatment, particularly racial inequalities, outcomes, and related provisions regarding protected characteristics” |
The purpose of this amendment is to include a fifth guiding principle to ensure that there is equity in treatment and outcomes addressing inequalities related to protected characteristics, particularly racial inequalities, in the operation of the Code of Practice and the Mental Health Act 1983 more generally.
Baroness Tyler of Enfield (LD)
My Lords, in moving Amendment 1 standing in my name, I will also speak to Amendment 3 in my name. There are other important amendments in the name of the noble Baroness, Lady Whitaker, in this group.
Before I turn to my two amendments, I would like to make one general point. On these Benches we very much welcome this long-overdue Bill and will work with others to strengthen it further. The 1983 Act, which we are amending, is more than 40 years old and no longer reflects current understanding, attitudes or best practice in relation to severe mental illness or learning disability and autism. We need to ensure that the final law is truly fit to serve people’s needs for years to come, and our proposed amendments reflect a comprehensive effort to strengthen mental health services by promoting equity, tackling racial disparity, supporting the well-being of children and young people and ensuring that adequate resources are in place to deliver the Bill’s provisions.
A brief look back at the history shows that significant changes to mental health legislation happen on average every 15 to 20 years. That is understandable because it takes time for legislative reforms to take shape and be implemented. This Bill is likely to be the legislation that impacts on the health and well-being of people with mental health conditions for the next two decades. During our debate, we will be raising issues. It may not be possible to deal with them all in the legislation but they are important to mental health services overall, so I hope the Government will view them as part of a wider package of reform, be they issues around resources in the community or the interface between this Bill and the Mental Capacity Act. It is all part of our wider scrutiny, and I hope that the Government welcome that.
Amendment 1 would add a fifth principle to the existing four set out, which of course I fully support, and provide additional momentum towards the goal of addressing the racial disparities in the Mental Health Act. I believe that making equity one of the guiding principles, as in my amendment, would give it far greater clarity, weight and focus. If we look back at the underlying rationale for this legislation, addressing inequalities, particularly racial inequalities, is one of the key issues identified in Sir Simon Wessely’s review of the Act and is one of the key drivers behind this Bill. However, concerns remain in the sector and beyond that the Bill as drafted does not go far enough to address this deeply entrenched inequity. Adding such a principle would also reflect existing duties under the Equality Act and the requirements of the patient and carer race equality framework, a point made by many noble Lords at Second Reading. This would go some way to recognising one of the key drivers behind reforming the Act: to address racial disparities.
I will give a quick reminder of the key facts. Black people are more than four times as likely to be detained under the Act than white people. Black people are over seven times more likely to be placed on a community treatment order, a CTO. On average, people from racialised communities have a worse experience of care and worse outcomes, and black and black British people are more likely to be detained for longer and to experience repeated admission. They are also more likely to be subject to police powers under the Act and to experience higher levels of restraint than white people. These are gaping disparities in the use of the current Act, and we must ensure that the Bill does something about them.
My Amendment 3 is intended to probe whether the principles in subsection (2B) will be statutorily binding. Given that the code can only reflect law and act as guidance, placing the guiding principles in the code leaves a loophole in which they can be deviated from. That is the purpose of this amendment. The Bill provides an updating of the principles to be contained in the statutory code of practice, and that is welcome, but it does not include the statutory principles appearing in the legislation in the way that principles appear in Section 1 of the Mental Capacity Act 2005. I am not clear about the reason for this distinction between the two pieces of legislation, hence this probing amendment. I would welcome an explanation from the Minister of the thinking behind this distinction.
I am aware of strong views held by those working in the sector that it is hard to understand how the principles will be binding unless they are included in the Bill itself. Many feel that this would have much greater force than simply being referenced as “things the Secretary of State must consider” when writing the code. There is also case law. Back in 2005, R (Munjaz) v Ashworth Hospital Authority made it explicitly clear that the Mental Health Act code is guidance rather than instruction.
Baroness Whitaker (Lab)
My Lords, I first apologise for not having been able to speak at Second Reading; I would have welcomed the Bill. In speaking to Amendments 2, 49, 52, 60, 112, 114, 118, 119 and 126 in my name, I declare my interests as honorary vice president of the Royal College of Speech and Language Therapists, as a former member of the Tavistock and Portman NHS Foundation Trust board, as a patron of the British Stammering Association, and as a stammerer myself. I thank the Royal College for its briefing and my noble friend Lord Bradley and the noble Lord, Lord Patel, for their support. I also warmly support Amendment 1 in the name of the noble Baroness, Lady Tyler. I shall add amendments consistent with it in a later group.
My amendments, which are supported by 49 professional, charitable and training organisations, are all based on the premise that speech and communication difficulties are an insufficiently recognised component of a very great number of mental ill-health symptoms and that professional speech and language therapy could—and should—enable more successful treatment. One study found that 80% of people accessing mental health services had a difficulty with language and 60% with communication or discourse. Especially in the case of children and young people, those with a mental health disorder report having five times more speech or language problems than those without. One study found that 81% of children with social, emotional and mental health needs had significant unidentified language deficits.
One of the problems with the lack of specialised staff to help such children is the demoralisation or challenging behaviour that comes from frustration with unmet communication needs, quite apart from the impediments to treatment. I could quote many examples of this, as well as some success stories—for instance, where speech and language therapy effected a sizeable reduction in the use of restraint in a secure children’s home, or enabled psychological treatment to work and give the inestimable benefit of the ability to cope. I must emphasise that most of us take the ability to communicate for granted, perhaps without realising how essential it is to our lives. It is when it is lacking that you notice what it means. I am therefore sure that it must underpin the principles of this excellent Bill.
Amendment 2 does that. Without a rider of that kind to the principles, we will not have effective treatment in very many cases of acute distress and challenging behaviour. Amendment 49 puts the speech and language therapist squarely in the frame of responsible clinician, so that where communication difficulties are the key problem, that can be tackled. Amendment 52 does the same for treatment decisions and Amendment 60 for care and treatment plans.
Amendment 112 provides the same safeguard for detained patients who need to complain and Amendment 114 is to make sure that patients can understand their information on discharge, which is surely essential. Amendments 118, 119 and 126 have a similar function: to make sure that advance choice documents are properly understood and properly made.
Lord Bradley (Lab)
My Lords, I rise to speak in support of Amendment 2, to which I have added my name, but first I declare my interests as listed in the register, especially as honorary vice-president of the Royal College of Speech and Language Therapists and as an honorary fellow of the same organisation. I am able to speak briefly as a result of the excellent explanation of these amendments by my noble friend Lady Whitaker, which I am pleased to support.
As we have heard, the lead amendment would place a requirement in the statement of principles to specify in the table the communication needs of the individual and recognise the disability, difficulty or difference to ensure they will be identified and supported. This requirement then flows throughout the Bill—as evidenced by the number of amendments to which I have also added my name—ensuring a thread of consistency for this vital area of support. These include, as we have heard, Amendments 49, 60, 112, 118 and 126, but I will not speak specifically to each of those and test the patience of the Committee.
The importance of Amendment 2 is clearly laid out in the excellent briefing, as we have heard, prepared by the Royal College of Speech and Language Therapists and endorsed by at least 46 related organisations representing this crucial area of work and service.
As we know, communication is fundamental and foundational to human life. It is central to how we express ourselves, how we understand others and how we interact. It is also fundamental and foundational to the aims of this Bill. It underpins the principles to inform decisions and is key to the matters to be addressed. Crucially, it ensures the individual is properly involved in the decisions taken as a consequence of this legislation. As we know, many people accessing mental health services have some form of communication disability, difficulty or difference. This can affect whether they are able to make themselves understood, understand what is being said to them, and how they interact with people. Left unidentified and unsupported, it can subject people to a range of negative outcomes, including inaccessible referrals, assessments, treatment and care and, potentially, unnecessary detentions and detentions longer than necessary.
I first recognised this issue when I undertook my independent report for the then Government, published way back in 2009, about people with mental health problems or learning disabilities in the criminal justice system. At that time, I identified appropriate adults as a key group to support people with communication issues and recommended that they should receive specific training to ensure the most effective support. They still play an invaluable part in such communication. I also recommended the establishment of liaison and diversion services, and I am pleased that in the subsequent years they have been rolled out across the country and we now have 100% coverage for that service.
These liaison diversion teams, placed in police stations and the courts, identify, assess and support people with complex needs, including mental health problems, to try to divert them away from the criminal justice system and support them along the criminal justice pathway. I recognised during this rollout that certain key additional services should be connected to the teams, including speech and language therapists, to enhance the support required for these people with communication difficulties in a variety of settings and circumstances. As the speech and language therapists who I have met over the years themselves identified, these many situations and settings include significant unmet communication needs among individuals on mental health wards, challenging behaviour relating to communication needs, lack of staff knowledge and skills in relation to communication needs in people with mental health conditions, and many more.
Although it is welcome that the Bill’s Explanatory Notes highlight that a care and treatment plan
“may also contain other information, for example, how the patient’s communication needs will be met”,
clearly this is not sufficient. The Bill must therefore be strengthened to make it explicit both that communication is central to the Bill’s aims and that
“communication disability, difficulty, or difference”
must be identified and supported. This would help to ensure that people receive the best possible treatment and care to support their recovery, including through the necessary reasonable adjustments that should be made. It would also help to reduce the risk to them, including of their being unnecessarily detained, and to assure the wider public. These issues must also be fully covered in the code of practice. I hope therefore that the Government will recognise the importance of such communication being in the Bill and look forward to the Minister’s response on these points.
Lord Patel (CB)
My Lords, I will speak briefly in support of all these amendments, including Amendment 114 in the name of the noble Baroness, Lady Whitaker. I apologise for having to scratch my name from the speakers’ list at Second Reading, as I had been struck down by the dreaded virus.
In all areas of healthcare, communication between patient and healthcare professionals is extremely important for diagnosis and treatment, and to achieve the necessary outcomes. This is drummed into medical students and other health professionals daily.
I declare an interest: I am an honorary fellow of the Royal College of Psychiatrists—an honour awarded to me by the noble Baroness, Lady Hollins, who is not in her place, when she was its president. The citation of unknown accomplishments in mental health on my part was read out by the noble Lord, Lord Alderdice, who is also not in his place.
I remember, however, that although my professor at the time, Sir Ivor Batchelor—a well-known psychiatrist—was a quiet man, during our psychiatry clinical attachments he used to drum into us that not all mental health patients can communicate well. We had to be patient to learn and understand their ways of communicating to help them communicate their problem. I had forgotten that I was taught that; at the time, I think he hoped that he would make us all psychiatrists, but that did not happen.
The noble Baroness, Lady Whitaker, has highlighted the extent to which patients with mental health problems have communication disability, difficulty or difference. NHS Digital research has shown that children and young adults with mental health problems are five times more likely to have communication problems, and that in 81% of children with social and emotional needs their needs remain unidentified. Even without communication disability, difficulty or difference, people with chronic acute mental health problems also show communication problems.
As the number of people with complex mental health needs increases, so does the need for more speech and language therapists. Very few multidisciplinary teams include such professionals and, where they do, most of the professionals work in in-patient settings. NHS Digital research suggests that there are about 256 such professionals, mostly working in in-patient secure settings. The provision of such services in community settings is patchy or non-existent, leading to long waits.
Baroness Murphy (CB)
My Lords, I shall speak to Amendment 49 on this issue. I do not disagree with anything that has been said about the vital need for communication and to ensure that the patient understands what is happening and has access to specialist help. But I particularly want to comment on the proposal that speech and language therapists should become responsible clinicians.
The role of responsible clinician under the Mental Health Act is really quite onerous. Of the 50,000 or so clinicians who take on the role and are appointed the responsible clinician when somebody is detained, the vast majority are consultant doctors. Fewer than 100—0.002%—have been psychologists or nurses. The appetite for taking on this role is low and, of all the members of the team who could take it on, it would be appropriate only in a very small minority of cases for it to be speech and language therapists. I do not want to rule them out because I know how valuable these people are, but we must see that, in practice, this will probably not fly very far. It is important that we concentrate on how we get proper communications, but this particular amendment would probably not find favour. I do not think that profession is yet trained to the full extent of what would be required for that role. Although I hope that it will be one day, this Bill is maybe too early for it.
Lord Patel (CB)
My Lords, with the greatest respect to the noble Baroness, I did not suggest—and I did not hear any other noble Lord suggest—for a minute that language and speech therapists would become clinicians in their own respect. I said that they would be part of a team that would help to establish appropriate communication. As doctors, we are not the best people for that—so I do not see how the amendment cannot fly, when there is a need for such people.
Baroness Murphy (CB)
I entirely agree with the noble Lord. However, the reality is that the responsible clinician, as mentioned in Amendment 49 to Clause 10, has a wide range of roles. It is very onerous and specific, so this is not likely to be a good idea for a speech and language therapist. I agree with the rest of what everybody has said.
Baroness Butler-Sloss (CB)
My Lords, I declare an interest as an honorary fellow of the Royal College of Psychiatrists, but without any qualifications, unlike the noble Baroness, Lady Murphy. For the reasons that have already been given, I entirely agree with the whole group of amendments, which have been proposed so much better than I could do—so I do not propose to say any more.
Baroness Berridge (Con)
In supporting Amendment 1, I am delighted that the noble Baroness, Lady Tyler, began Committee with this focus on the impact of the Mental Health Act on racialised communities, because that is where this whole journey began, with the noble Baroness, Lady May, when she was Prime Minister, announcing it in that context—and then, of course, it became a wider reform of the whole Act.
I served on your Lordships’ Joint Committee with the other place, scrutinising the Bill. In the course of that, I became aware of the relative strengths of civil society among some of the groups. There were excellent civil society groups speaking on behalf of people with learning disabilities and autism; they were highly professional and articulate. We had one evidence session on the effect of the Mental Health Act on racialised communities, but I saw that the strength of civil society and of media coverage in that area was less—so I am sympathetic to Amendment 1, which would give a profile to one of the main issues under the legislation.
On whether the table should be in the Bill to be in the code or in the Bill sitting as primary legislation, I have sympathy for that proposition. We have learned that the code of practice merely reflects primary legislation. I am aware, of course, that the independent review came up with those four principles, and this fifth one was not part of that. I expect to hear the Minister say that it is already in the Equality Act, so we do not need to put it in the Bill—but I am persuaded of the merits of the amendment. During the whole process of an independent review, a White Paper, a response to a White Paper, a draft Bill, a Joint Committee and now the Bill before your Lordships’ Committee, it has become clear to me that many of the changes that ethnic minority communities need to see are in practice. They are in resources and training—people would not look to the Bill and see their needs as the first or an important priority in it. I would be grateful if the Minister would take seriously this consideration of putting this equity principle in the table and putting it in the Bill, full stop, and not within the code.
Lord Kamall (Con)
I begin by thanking all noble Lords who spoke to this first group of amendments in Committee. Before I comment, I refer noble Lords to my interests as set out in the register. I am not an honorary fellow of the Royal College of Psychiatrists, noble Lords will be relieved to know, but I should mention my previous work with a couple of think tanks—the Institute of Economic Affairs and Politeia, which have both published on health and social care issues. There is also my work at St Mary’s University, where I am a professor of politics and international relations, and which has recently applied to open a new medical school. I also sit unpaid on the advisory board of a start-up coalition, and I know that there are a number of start-up companies helping people with mental health conditions. I just wanted to cover those interests, in case anyone made any accusations.
This group addresses the principles that will guide the application of the Mental Health Act, as set out in the Wessely review. Sir Simon pointed out, rightly, that there are already guiding principles in the code of practice, but that
“there is limited awareness of these, and it seems very likely that they do not inform practice in the way they should”.
Clearly, as noble Lords said at Second Reading, the important aim of including the four principles is to improve their application and ensure the highest level of care and therapeutic benefit for patients, while ensuring that all patients are treated as individuals.
I thank the noble Baroness, Lady Tyler, for her Amendment 1. Of course, equity is at the heart of the Bill, as my noble friend Lady Berridge just said. The Wessely review was commissioned by my noble friend Lady May of Maidenhead with the intention of understanding why a disproportionate number of black people were being detained and receiving community treatment orders under the Mental Health Act. I think all noble Lords welcome the idea of including equity in principle, as long as it then feeds through into practice. That is the key here, and my question for the Minister is: would putting the principle in the Bill make a difference to practice? How do we make sure that it makes a difference to practice, rather than simply adding the words or adding the principle? One of the values in the NHS constitution is that “everyone counts”. Does this equality duty go further than that, and would it have a greater practical significance? That is one of the questions we need to dig out and probe the Government on.
The noble Baroness, Lady Tyler, makes an interesting observation with her Amendment 3. The principles were included in the Bill, as the Wessely review argued, to improve clinical practice. This is vital, because we know that the Mental Health Act is the legislation that is used to compel detention in hospital for treatment. This may very well raise awareness of the principles, but once again, how do we make sure that this is applied? We have to keep pushing this point, although I will not repeat it again, of making sure that this gets fed in to practice in the clinical setting.
I also note the amendments in this group of the noble Baroness, Lady Whitaker. I will not repeat the statistics that she read out about the impact of the lack of or inappropriate support for people with mental health issues or learning difficulties. Of course, it is not difficult to appreciate the complexities. Someone in my close family worked with speech and language therapists in his youth, and I could see the difference it made. It is almost too obvious to say, but how do you get your needs across if you cannot communicate them, or your needs are not understood by the person who is supposed to be offering treatment? As the noble Lord, Lord Patel, mentioned, this is included in the Explanatory Notes, but how do we make sure that it gets into the Bill and into practice? Obviously, it is a problem that is acknowledged by the Government, or it would not be in the Explanatory Notes, but why have the Government chosen not to go any further on this issue?
I was very struck by what the noble Baroness, Lady Murphy, said about Amendment 49 and her concerns. Will the Minister address that debate? Of course, we all want to make sure that patients feel that they are understood. We know that patients have to be supported as much as possible to make sure they get their point across and that they are understood, in order to give them adequate treatment, but I noted the concerns of the noble Baroness, Lady Murphy, even though the noble Lord, Lord Patel, intervened. Have the Government taken a view on this or does the Minister need to write to us? I look forward to her comments.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, I feel it necessary to start, instead of talking about the Bill, by offering our condolences to the noble Baroness, Lady Hollins, on the very recent loss of her dear husband, and to thank her, as I know all noble Lords will do, for her close engagement on these reforms over many years. I say to the noble Baroness, who said she would be watching if she could, that we absolutely understand why she cannot be with us today. We miss her and I know that the thoughts of all noble Lords will be with her at this very sad time.
If I may make a few general points, as we know, this legislation has been in development for many years. I put on record my thanks for the collaborative and constructive nature of that work and the discussions I have held in my post over the past few months with Peers on all sides of the House. I extend my appreciation to the former Prime Minister, the noble Baroness, Lady May of Maidenhead, for her highly significant role in commissioning the independent review which informed this Bill and to Sir Simon Wessely and all those who worked on this landmark review, which provided a blueprint for this Bill. Like other noble Lords, I am very pleased to have got to this point.
Baroness Whitaker (Lab)
I apologise for interrupting my noble friend’s eloquence, but it is not the case that speech, language and communication difficulties are a protected characteristic. Can she absolutely assure us that they do come under the Equality Act?
Baroness Merron (Lab)
I am grateful for my noble friend’s intervention. I will later make specific points about speech and language therapists.
The revised code of practice will give guidance for decision-makers and those involved in care and treatment on how to support individuals with communication needs to make sure that their voices are heard. Following Royal Assent, we will draft, and consult on, a code of practice, and it will be laid before Parliament. In addition to the code, we will lay secondary legislation to support the reforms set out in the delegated powers memorandum. I am committed to sharing papers setting out further details on this, including what we expect the content of care and treatment plans to cover, some of which is highly relevant to this debate.
Amendment 3, in the name of the noble Baroness, Lady Tyler, and also spoken to by the noble Lord, Lord Kamall, would mean that the individuals and organisations referenced in Section 118(1) of the Mental Health Act 1983 must have regard to the code of practice when making decisions. It seeks to probe whether the principles set out in the table in Clause 1 of this Bill—under new Section 118(2B) of the 1983 Act —will be statutorily binding. Practitioners are already under a statutory obligation to take account of the code when making decisions under the Act. Anyone who must have regard to the code of practice under Section 118(2D) must therefore also have regard to the statement of principles that the Secretary of State must include in the code when carrying out specified functions under the Act. That includes all those referenced in Section 118(1).
The Government expect practitioners to follow the code. Anyone seeking to depart from it must have compelling reasons for doing so. Reasons for any departure must be recorded clearly, as courts have the power to scrutinise such reasons to ensure that there is sufficiently convincing justification for not following the code.
I believe that this is the right approach, because relevant individuals and organisations must have regard to the code and, in turn, the principles. But the system is not so inflexible that a principle must be followed irrespective of the circumstances, because there could be very rare cases whereby it could create a risk that an individual is not being treated according to their own particular needs, which is not the intention of the Bill.
Lord Scriven (LD)
I think the Committee would understand that if it was to do with a therapeutic intervention. This is about the principles according to which clinicians and others have to work when dealing with the Act. First, can the Minister enlighten the Committee as to which principles, as a framework, would not be suitable for a particular patient? It is a principle. Secondly, my noble friend tabled this amendment because case law on codes of practice in the public sector goes back to 1998 and Regina v Islington Borough Council, in which the court made it very clear that public bodies have the right to deviate on admissible grounds where there is good reason. I can see no reason, unless the Minister can give one, why deviating from a principle is acceptable. That is why my noble friend wants the principles to be in the Bill. I could understand if it was a restrictive practice, but it is not; it is a principle.
Baroness Butler-Sloss (CB)
To add to what the noble Lord, Lord Scriven, has said, I am having a problem understanding why the code is not statutory.
Baroness Merron (Lab)
I thank noble Lords for their interventions, for which I am grateful. They give me the opportunity to say now what perhaps I should have said at the outset: I will of course reflect on all the points that are raised as we move forward. I will be honest and say that I am not sure that what I am about to say will do justice to the points that have been raised. Overall, the real concern is about making very complex legislation even more complex. We are wrestling with our attempt to update the Mental Health Act—we are not starting from scratch. That is the point I would like to like to move on to.
The noble Baroness, Lady Tyler, raised a comparative point about the Mental Capacity Act and asked why, if that could include principles, it is not possible for the Mental Health Bill to. To extend what I have just said, it is because the Mental Capacity Act was structured around principles from the outset when it was drafted and did not have to meet the challenge that we are trying to debate today. As I said, we are currently looking at amending the existing Mental Health Act, which has not been designed or structured around statutory principles. In my language, I would say that we are starting from an entirely different place.
Baroness Berridge (Con)
I hate to interrupt the Minister’s flow, but we are going to come back to the code of practice again and again. Can she outline whether we will get to see a draft of that code? If the argument from the Government is that it needs to be in the code and not on the statute, it would be very helpful to see a draft code of practice before Report, at the very latest.
Baroness Barker (LD)
Those of us who were here in 2006 listened to the Minister’s predecessor at the Dispatch Box making pretty much the same speech that she has made now, and nothing has changed in the meantime. We are trying to do what we can to make sure that we do not have the same situation for the next 20 years.
I take the point that the Mental Health Act 1983 was not built on principles. Does the Minister accept that it is time that we moved forward to a situation where both the Mental Health Bill and the Mental Capacity Act are built on principles, including that the people who are subject to them have rights to dignity and so on, as we have seen set out in different places, and that if they are not treated in that way they have the right to take people to court?
Baroness Merron (Lab)
I thank noble Lords for their interventions. I will take the point from the noble Baroness, Lady Berridge, first. Following Royal Assent, we will be drafting and consulting on a revised code of practice, which will be laid before Parliament. We will be working with key partners to ensure that everyone is trained in the new Act before the first major phase of reforms. I hope that that will be helpful.
I hear the disappointment in the comments of the noble Baroness, Lady Barker. On her request for specific examples, I will need to write to noble Lords on that. I hope noble Lords realise that not having the principles in the Bill, as the amendment refers to, does not mean that there is less intention that they apply. For me, it is about the way of getting there, rather than the commitment to it. However, I hear the question about that point.
Amendment 49, on the matter of speech and language therapists, is in the name of my noble friend Lady Whitaker, supported by the noble Lord, Lord Patel, and my noble friend Lord Bradley. I turn first to the question raised by my noble friend Lady Whitaker. It is true that not all speech and language difficulties or differences would count as a disability under the Equality Act 2010, so my noble friend makes a relevant point.
The definition of who can and cannot be approved as an approved clinician was spoken to by the noble Baroness, Lady Murphy, and the noble and learned Baroness, Lady Butler-Sloss. That definition is set out not in primary legislation but in instructions issued by the Secretary of State, under the power in Section 12ZA of the current Mental Health Act. These instructions have the same status as secondary legislation, so it is our belief that it would not be appropriate to specify in primary legislation that speech and language therapists can be approved clinicians, because all other professional groups are covered only in the instructions.
For that reason alone—but noble Lords should bear with me—we will seek to reject this amendment. However, I can commit that we will be revising the statutory instructions under Section 12ZA following the passage of the Bill, and we are very happy to consider extending the criteria to include speech and language therapists. I offer an invitation to the royal college to discuss this matter with the department and to consider how it can work to support and encourage those of its members who may be interested in this role.
I am aware that time is not on my side. However, a number of amendments in this area have been tabled—
Lord Kamall (Con)
I wonder whether I can be of help to the Minister. The timing is advisory so, if there are important points that the Minister wishes to make, she should please go ahead.
Baroness Merron (Lab)
I have never had so much encouragement to carry on speaking. Noble Lords will be glad to know that the flashing clock always makes me very nervous. I thank the noble Lord, Lord Kamall.
Baroness Murphy (CB)
Can I just add to what the noble Lord, Lord Kamall, just said? I have never before sat through a Committee where the Minister has been restricted in going beyond any advisory time. She should say what she darn well likes. She may have to respond to an awful lot of complicated spots in this; there is no reason at all why she should not carry on, in my view—and that of everyone else in the Committee, I think.
Baroness Merron (Lab)
I am extremely grateful to the noble Baroness for helping me out there.
I referred to my invitation to the royal college. Given this commitment to pursue these changes, that will be subject to agreement with the royal college. I hope that will be of assistance to noble Lords.
I turn now to Amendment 52 in the name of my noble friend Lady Whitaker, supported by the noble Lord, Lord Patel, and my noble friend Lord Bradley. It seeks to ensure that clinicians consider a patient’s communication needs and make reasonable adjustments as part of the new clinical checklist; this requires clinicians to consider a number of matters when deciding on a patient’s treatment, with the aim of making treatment more patient-centred.
We share the goals of this amendment. However, the checklist already requires the clinician to take steps to assist and encourage the patient to participate as fully as possible in the decision-making process. We consider assistance to include making reasonable adjustments to account for a patient’s communication needs, which is something that noble Lords have rightly raised as being of concern. We very much intend to make this clear in the code of practice, which will already provide specific guidance on the need to make reasonable adjustments under the Equality Act. For example, the clinician should provide information in an accessible form, perhaps by involving an interpreter, a signer or someone who can communicate via the person’s preferred communication method.
My noble friend Lady Whitaker has also tabled Amendment 60, supported by the noble Lord, Lord Patel, and my noble friend Lord Bradley. It seeks to ensure that the new statutory care and treatment plan introduced by the Bill covers
“information about a patient’s communication disability, difficulty, or difference”,
and how these might be identified and supported. The Bill makes it clear that a statutory care and treatment plan is a plan made in accordance with regulations, so we intend to set out in regulations that a patient’s plan must include, among other things, information that is important for the treating clinical team to be made aware of during the patient’s detention. This is to encourage the treating clinician, as noble Lords have spoken about, to consider the individual needs of patients—including communication needs—so that the appropriate reasonable adjustments can be made. A record of how their needs will be supported should be evident throughout their plan, which should, as far as possible, be developed in consultation with the patient and others, such as their family members.
Regarding the identification of any communication needs, as already set out in the Mental Health Act code of practice under the Equality Act, mental health professionals should already be identifying and making any reasonable adjustments to account for a person’s communication needs. Where applicable, a patient’s care (education) and treatment review may also identify and make recommendations about a patient’s communication needs. We intend to set out in regulations that these recommendations must be attached to the patient’s statutory care and treatment plan, so that they can inform planning and delivery of care. I hope that this will reassure noble Lords that the patient’s statutory care and treatment plan should cover any communication needs and how they will be met, but in reflecting on this debate I will ensure that the actions we are proposing take account of this.
Amendments 112 and 114, tabled by my noble friend Lady Whitaker, would require managers of hospitals or registered establishments to provide information in an accessible format when discharging duties under Clauses 39 and 41 to give information on complaints to detained and conditionally discharged patients. I agree that it is important that all patients can access information about their detention, including the complaints process, and in a format that is accessible to them. However, the clauses are already drafted with the overriding obligation that the patient is helped in whatever manner is practical to understand the information being given to them. Therefore, it is unnecessary to add the words in the amendment proposed by my noble friend. Additionally, hospital managers have an existing duty under the Equality Act to make reasonable adjustments based on disability, which is the legal basis for ensuring that information for patients is accessible.
I reiterate that I understand that communication needs will not always be related to the letter of the Equality Act. There is already guidance in the mental health code of practice on how a patient’s communication needs should be considered when providing information on complaints. When we come to revise the code, we will engage with stakeholders to explore whether further guidance on the complaints process, including how information on complaints should be provided, is required.
Amendment 118 in the name of my noble friend, supported by my noble friend Lord Bradley and the noble Lords, Lord Patel and Lord Bourne, seeks to ensure that the advance choice document template is available in a format that the service user can understand. We strongly agree with the principles of this amendment and are committed to mitigating any barriers that people may face to creating an advance choice document or making their wishes and feelings known in advance. Where a person wishes to make an advance choice document, our intention is that they are given a standard template to complete, alongside supporting guidance and, where the individual wishes to receive it, the support of mental health practitioners. The template should prompt the individual to think about the sort of things they may wish to consider and decide in advance of becoming unwell. We will work to develop these resources.
We also plan to set out in guidance to health commissioners that these resources and the support provided by mental health practitioners must be delivered in a way that is accessible to individuals and that responds to their needs. That will be in line with the Equality Act and the public sector equality duty. Of course, if a person wishes to create a record of their wishes and feelings in another format that is easier, they absolutely may do so. We have purposefully made it that individuals do not need to complete a prescribed form in order for their advance wishes and feelings to be considered at a later stage. I agree with the need and hope that this will provide maximum accessibility and increase patient voice and autonomy.
Finally, Amendments 119 and 126, tabled by my noble friend Lady Whitaker and supported by my noble friend Lord Bradley and the noble Lord, Lord Patel, seek to ensure that the support provided to people to create an advance choice document is responsive to the needs of people with a
“communication disability, difficulty or difference”.
I agree that is important. To achieve this, it is important that support and information around advance choice documents respond to people’s needs individually, so that no one is unfairly disadvantaged. That includes communication needs.
Baroness Tyler of Enfield (LD)
I thank the noble Baroness for her extremely comprehensive but very helpful response to all the amendments, and I am happy to withdraw.
“Application of the Mental Health Act 1983: autism and learning disability(1) Section 1 of the Mental Health Act 1983 (application of Act: “mental disorder”) is amended as follows.(2) Omit subsection (2A).(3) Omit subsection (4).(4) At end, insert—“(4A) Mental disorder does not include autism or learning disability for the purposes of this Act.””
Baroness Bennett of Manor Castle (GP)
My Lords, in moving Amendment 4, I will speak to the Schedule 1 stand part notice, which is consequent on Amendment 4. Both appear in my name. I will not speak to the other amendments in this group, although my understanding is that Amendments 5 and 38 to 41 inclusive—tabled, variously, in the names of the noble Baronesses, Lady Browning and Lady Hollins, and the noble Lord, Lord Scriven—are effectively trying to achieve the same thing but by different means. I will leave them to speak to their amendments, because I want to explain why I have structured mine in this way.
I must begin by thanking Jen Smith at the Bill office for her great patience and expert assistance to this non-lawyer in producing this and a number of other amendments. I also want to stress that I am not, unlike many people taking part in this debate, an expert in this area, but I seek to represent voices of people who have reached out to me who may not otherwise be heard in your Lordships’ Committee.
I will set out the background to Amendment 4. I had a detailed briefing from the group Liberation, a user experience group led by people who have experience of mental distress and trauma, which has the slogan “for full human rights”. It is seeking a complete end to involuntary detention in psychiatric hospitals and forced treatment for the people it represents—people given mental health diagnoses. It asked me to exclude all people from what is known as detention or sectioning.
Liberation says that involuntary detention and forced treatment are forms of disability-based discrimination, and these people should not be subject to them. This may not be the case under the European Convention on Human Rights—I acknowledge that the noble Baroness, Lady Merron, signed a statement to that effect in the Bill—but I understand that it can be argued to be the case under the UN Convention on the Rights of Persons with Disabilities. I note, however, that the Parliamentary Assembly of the Council of Europe has, in line with Articles 12 to 14 of the UN CRPD, strongly endorsed a complete end to involuntary hospitalisation and compulsory treatment and recommended the removal of Article 5.1(e) from the ECHR—the paragraph that limits right to liberty if people are judged to be “of unsound mind”. It describes it as
“not compatible with our 21st-century understanding of human rights”.
I note that the recent report on the situation in the UK from the UN Committee on the Rights of Persons with Disabilities, particularly paragraphs 79 and 80, expresses concern about the lack of government measures to end disability-based detention and that the then Conservative draft mental health Bill continued to allow involuntary detention and forced treatment. The Bill brought before us by the Labour Government still has the same kind of provisions. The argument is that the Bill as it stands remains non-compliant with the UN CRPD deinstitutionalisation guidelines and the World Health Organization publication Mental Health, Human Rights and Legislation: Guidance and Practice, in which countries are urged to replace institutions with high-quality services.
I can almost feel your Lordships’ Committee saying, “How can that be possible?” Starting from now, that looks like such a long way away. That was indeed the question that I put to Liberation, which presented me with a number of case studies from around the world. I imagine that the Minister is aware of the case of Trieste, in north-eastern Italy, which almost managed to abolish involuntary detentions. They have been replaced with wide-ranging and accessible community services, based on a whole-person approach. Its community mental health centres are open 24 hours a day, seven days a week, and they play a key role in preventing people reaching a point of crisis. This has enabled people with mental health diagnoses to remain in and be part of their local community, in line with Article 19 of the UN convention. Compulsory psychiatric treatment orders are still possible, but the numbers are very low and orders typically last seven to 10 days.
In Spain, Act 8/2021 recognises the legal capacity of all adults and stipulates that disabled people should receive the same legal treatment as non-disabled people, including those with mental health diagnoses and learning disabilities. This is still not complete equality but it is heading that way and has made further progress than we have.
Costa Rica, Peru and Colombia have all taken steps in this direction. In Peru, for example, a recent study on the impacts of crisis interventions indicates that involuntary detention rates have been significantly reduced and that, when people are detained, they typically leave hospital after a couple of days.
In Mexico, the general health law of 2022, a national civil procedure code, says that everybody has legal capacity, including people with mental health diagnoses. It enables access to supported decision-making for everybody. Mexico City, in particular, has set a real lead in delivering on this, but I acknowledge that not all of Mexico has.
Why have I tabled an amendment that would, in effect, end detention for those with autism and learning difficulties? I feel like I must apologise to the people I have spoken to, as I did not feel able to put down another amendment—this a probing amendment, by nature—as I looked at the realistic situation. The noble Baroness, Lady Tyler, in starting our debate, referred to the extreme lack of resources. I and many others have amendments later in the Bill referring to the need for it to specify the level of resources. I am sorry that I did not feel able, even in this probing stage of Committee, to table another amendment. I would like to, and I would very much welcome the Minister’s comments on how we sit in that UN framework and whether the Government have a long-term goal to reach the kind of levels that an increasing number of other countries have attained, as I have just set out in my quick survey.
But I have to look at the reality of the statistics. I have looked at the figures in the briefing from the Royal College of Psychiatrists. The number of recorded detentions in 2023-24 is 52,500. We really have to reflect on that number. Of those, we have seen a fall, to 1,880, in the level of detentions relating to learning disability and autism—that seems a step in the right direction. We are talking about disabilities. Can we really continue, a quarter of the way into the 21st century, to detain people for their disability rather than provide them with the support they need in the community? That is a question this amendment seeks to raise.
I want to reflect on the fact—we will come back to this again and again—that people are not getting the help they need, and that is leading to the state of crisis we have now. I note in Mind’s briefing that people are crying out for help and not getting it. In June 2024, very urgent referrals to crisis teams for adults were 45% higher than a year before. I should here declare my position as a vice-president of the Local Government Association and refer to the LGA briefing, which talks about the significant resource implications for councils of the Bill as it stands as presented by the Government.
There are voices here that should be heard. We should frame this in the context of the international situation of the UN Convention on the Rights of Persons with Disabilities. That is why I have tabled this amendment. I hope we can have a constructive discussion and see some real progress here today. I beg to move.
Baroness Browning (Con)
My Lords, I declare my interest as a vice-president of the National Autistic Society and a co-chair of the APPG on Autism, and I have responsibilities for close relatives who are on the autism spectrum.
I will speak to Amendment 5 first, and to the Mental Capacity Act, which is not the Act we are looking to change but it is my contention in this proposed clause that the Mental Capacity Act has a relationship with the Mental Health Act.
There has for some years been concern about the deprivation of liberty safeguards as defined in the Mental Capacity Act 2005. They were inserted into the Mental Health Act 2007 following the Bournewood judgment in the European court which involved an autistic man whose liberty was denied, whose carers were ignored, and who had had what I can best describe as an autistic meltdown that resulted in his incarceration for a very long time.
Although the Mental Capacity Act has much to commend it, there has been ongoing concern about the deprivation of liberty safeguards—often referred to as DoLS—and I managed to obtain a House of Lords inquiry into the Act in 2013, ably chaired by the noble and learned Lord, Lord Hardie, who is in his place today. I will quote a section of the summary of that inquiry that deals specifically with deprivation of liberty safeguards. The House concluded:
“The provisions are poorly drafted, overly complex and bear no relationship to the language and ethos of the Mental Capacity Act. The safeguards are not well understood and are poorly implemented. Evidence suggested that thousands, if not tens of thousands, of individuals are being deprived of their liberty without the protection of the law, and therefore without the safeguards which Parliament intended. Worse still, far from being used to protect individuals and their rights, they are sometimes used to oppress individuals, and to force upon them decisions made by others without reference to the wishes and feelings of the person concerned”.
Baroness Berridge (Con)
I pay tribute to the work that the noble Baroness, Lady Browning, has done in relation to this matter. This is a matter that we considered in great detail in the Joint Committee. I am grateful that that gives us the opportunity to discuss in the round the legal basis on which people are detained. The independent review did not recommend what is currently in the Bill, which is the removal of learning disabilities and autism from the Act. The Joint Committee’s report quotes it saying,
“the risk of completely removing learning disabilities and autism from the Act is too high”.
The noble Baroness, Lady Browning, outlined one of the reasons for that, which is that if you remove the legal basis for detention under the Mental Health Act, then the bucket that these individuals and patients would fall into without Amendment 5 would be the Mental Capacity Act.
In the consideration by the Joint Committee, there is the other danger that—when there is no co-occurring mental health condition—you end up with people coming through the criminal justice system, instead of being detained under the Mental Health Act. That is the worst of all the evils we could be discussing here today and would be completely inappropriate.
I would be grateful if the Minister will ensure two things when we know that these are dangers: first, an increase in diagnoses of co-occurring mental health conditions to use the Mental Health Act; and, secondly, an increase in the use of the Part III criminal justice provisions. It is important that we know the exact statistics for the group with learning disabilities and autism before implementation of the Act. Then we would know whether the Act has caused an increase in diagnoses of co-occurring mental health disorders and an increase in the use of the criminal justice system.
I believe that currently 39% of people detained with learning disabilities and autism are detained under Part III of the Act. I see the noble Baroness, Lady Browning, nodding. It is important that we remember that New Zealand tried this, removing learning disabilities and autism from its mental health legislation. I cannot remember whether it had the co-occurring mental health diagnosis provision, but, only a few years later, it had to amend the law, as it had caused an increased number of learning disabilities and autism patients to come in through the criminal justice system.
What would be the position if the Bill were amended in accordance with Amendment 5? The evidence that we received in Joint Committee was that there would be no patients—that community facilities would be at a level where they could not think of anybody who would need to be detained. I wish the world were thus, but the ideal world portrayed in that way does not exist. Even with the community facilities that we all wish to exist, it seems clear to me that there would be circumstances in which there would still be a need to detain.
I recognise that, in reality, we may see that increase in diagnoses of co-occurring disorders. Physicians may reach for that to protect someone—to detain them to get them treatment. However, it was made clear to us that 28 days is a relatively short time. You can be detained for assessment, but it can take many days to get the level of distress down—I do not want or like to use the word “meltdown”—to assess the mental health of the person and whether there is a co-occurring disorder.
The Joint Committee came up with a special exceptional tribunal that would still allow the Mental Health Act to be used in that small number of cases—once community facilities are as we would like them to be—to continue detention. Why? For the reasons outlined by the noble Baroness, Lady Browning: the protections under the Mental Health Act are much greater. You have the nominated person, you can go to the Mental Health Act tribunal, and—ker-ching—you get Section 117 aftercare, which, of course, is not available under the Mental Capacity Act.
If Amendment 5 were accepted, we would have no Mental Health Act, no co-occurring diagnoses, no criminal justice system—I hope—and no Mental Capacity Act to refer to. If a clinician is in that circumstance where someone is so distressed and they do not have that diagnosis in the 28 days, where is the law? We are not talking about the practicalities here. Where is the law?
In any event, the Mental Capacity Act does not apply to under-16s. So the risk would be an increased use of what we now know as High Court DoLS. These are not DoLS under the Mental Capacity Act. They are DoLS under the inherent jurisdiction of the High Court. They are a most unsatisfactory way of restraining the liberty of under-16s.
Only two or three weeks ago, the Children’s Commissioner issued a report outlining the problem, and outlining that, already, some children with learning disabilities and autism are under a High Court DoLS. It is a matter that your Lordships’ House needs to consider. Nearly a thousand children are detained under a High Court DoLS.
Obviously, the Mental Capacity Act would have applied to 16 and 17 year-olds and adults so where does that leave those vulnerable adults? Where is there a power to detain them? The Mental Health Act and the Mental Capacity Act will both have gone. If clinicians are in that circumstance where there is no co-occurring mental health disorder, there is a vacuum which may end up being filled by the inherent jurisdiction of the High Court using vulnerable adults. We will have created another little bucket of people. I accept the criticism made by the noble Baroness, Lady Browning, about DoLS under the Mental Capacity Act. They are supposed to be replaced by protection of liberty safeguards, but those are not in force yet.
If we accept Amendment 5, are we going to create more work for the High Court with clinicians in that situation because the law will not have provided any means for them to detain? I recognise and repeat that the practicality will probably be a co-occurring mental health disorder but, as far as I understand it, that is where the law will be left if Amendment 5 is accepted.
Although the Mental Capacity Act is far from ideal, I hope the Minister can help us understand what the situation would be if we were to accept the amendment. As I say, for the under-16s it would be more cases under High Court DoLS, as far I understand it.
Baroness Murphy (CB)
My Lords, I have an amendment in this group but I want to speak particularly to the amendment from the noble Baroness, Lady Bennett, and to thank the noble Baroness, Lady Berridge, for her good sense. I agree with every word she has said.
I had earlier tabled amendments to Clause 3 and Schedule 1 to give effect to opposing any change in the definition of mental disorder for the meaning of the Act in the same way as Sir Simon Wessely’s committee recommended and I withdrew them in favour of a compromise amendment because I was not sure, to be honest, that I would get here at all today. I have. I am not quite sure how many more I will be able to get to but for the moment I am here so I will speak to this one.
I want to make it clear right from the start that if we had changed our legislation to be a hybrid Bill that was a fusion of a mental capacity and a mental health Bill we would not be in this pickle because we would have capacity-based legislation and therefore we could have proceeded without any of these silly criteria for what is this diagnosis and what is another. As the legislation is at the moment, I believe the move to remove autism and learning disabilities from what is a mental disorder is frankly bizarre, akin to having Parliament establish that for the purposes of legislation, the earth is flat and the sun goes round the earth. Galileo had the same problem. I want to ensure that Hansard will record that not everyone is in agreement with the notion that autism and learning disabilities are somehow separate and different from other mental disorders.
Neurodiversity, which, of course, exists, is the term used to describe statistical outliers from the norm and, of course, as for many other mental states, there can be many positive and interesting aspects of alternative ways of thinking about and responding emotionally to the world that enrich society. I understand that many people with autism and learning disabilities do just that and that is where neurodiversity has been so supported by people who want to ensure that they are recognised as individuals and citizens just as the rest of us are. But that does not change the fundamentals.
I know noble Lords know that I was a professor of psychiatry for many years at the University of London but I ought to mention at this point that I also have a special interest in mental health legislation because I was for six years vice-chair of the Mental Health Act Commission. I co-authored this now much revered code of practice for the 1983 Act. It is actually my only bestseller—if only it did not say Secretary of State on it—and I know first-hand how the Acts and codes are used. That is why I do not get involved in the principles of where this should be. The code does have statutory effect, by the way—I am sorry that the noble and learned Baroness, Lady Butler-Sloss, has left, because I can reassure her it does have statutory force. I was also UK advisor to the WHO on mental health and older people and was exposed to the developments in mental health legislation in other jurisdictions, not only in the UK, with the Scottish and Northern Ireland Acts as they were being developed, but in the Republic of Ireland when it introduced its new Act, and abroad in English-speaking legislatures.
Baroness Browning (Con)
The noble Baroness asked me a question. Was it rhetorical? I wonder whether she could accept that autism is different. From the time that Kanner first identified autism, which is what a lot of psychiatric bases are based on—we then had Asperger and others, and the very good, more recent documentation from Lorna Wing, with whom I am sure she is familiar—autism has been different. If people doubt that, it is important to note that, apart from the Mental Health Act, the only other condition, however you label it, to have its own Act of Parliament is autism. In the Autism Act 2009, this Parliament unanimously agreed—in both Houses—that autism is different and deserved its own Act of Parliament.
Baroness Murphy (CB)
I would say that all mental disorders are different but that they cannot all have their own Acts of Parliament. I do not accept that autism is different. Of course, it is different in the way that it manifests—
Lord Stevens of Birmingham (CB)
I will make a slightly cheeky intervention, if I may, on the noble Baroness. I am not weighing into the debate that is taking place but simply make this point. Does she accept that the fact that a condition is listed in the DSM or the ICD is not itself definitive? Until 1973, homosexuality was listed as a psychiatric condition in the DSM and until 1990 it was, I believe, included as a psychiatric diagnosis in the ICD. Therefore, that is not the strongest evidential basis for her claims.
Baroness Murphy (CB)
I agree with the noble Lord, but the reality is that we use DSM-3 and ICD-11 in the international classification of disorders. If we in Britain are to go outside that, for reasons of our own, then we had better have some pretty good ideas why that should be. I am not so sure that we have them.
The Wessely review rejected the notion because, as the noble Baroness, Lady Berridge, said, it carried serious risks that individuals would be extruded and neglected, the opposite of what is intended. Similar anxieties were expressed in the development and creation of other Acts—I am sorry that I am going to go on longer than the advisory—so as not to exclude anybody from this group, because we want mental disorder to be an inclusive thing and not to exclude whole groups of people. Their protections are gone if we exclude them.
I accept that almost all the developments for autism and learning disabilities in the Bill are very positive. They will really improve the way that people think about autism and will have an extremely beneficial effect on trying to develop services and improve training, but there is no evidence that changing the criteria under the Act will do anything to improve it. Getting money into services and service design is what we need and not a change in the legislation for criteria. As the Royal College of Psychiatrists’ group of specialists in learning disabilities have pointed out, the vast majority of them do not want this change in legislation. We should think very carefully before we submit people to something when we do not know what will be unleashed as a result.
Lord Scriven (LD)
My Lords, I wish to speak on this group; I have tabled two amendments, Amendments 38 and 40. I declare an interest as a vice-president of the Local Government Association. I also wish to share an interest which is similar to that of the noble Baroness, Lady Browning. I used to have two nephews who had learning disabilities and autism. One of them, sadly, has died—there is a statistic that people with learning disabilities and autism die, on average, at 20 years below people without them. I still have a loving, warm, neurodiverse and very proudly different nephew, who I love. I see his behaviours and the way that many people do not understand him and deal with him differently.
I listened carefully to the noble Baroness, Lady Murphy, and was going to make the exact point that, as a gay person, before 1973 I would have been defined as having a mental illness. The discussion among psychiatrists and the mental health professions at the moment is not as robust as the noble Baroness made out. Many people within the profession say that those with learning disabilities and autism are not on the mental health spectrum and should not be treated as having a psychiatric illness.
We are in a difficult position. My amendments are probing amendments to try to preclude Sections 2 and 3 of the Mental Capacity Act being used to detain people who do not meet the Mental Health Act detention criteria. It is fascinating that, in some cases where people are detained at the moment, it is not because there is a therapeutic benefit but because there are no community facilities—this is completely at odds with the code of practice. Professionals are using a lack of facility to detain people. Let us be clear: these people are detained for 4.8 years on average, in solitary confinement, and this has a lifelong detriment. They are scarred for life. Many probing amendments in this group are trying to tease out exactly what will happen and to ensure that the Mental Capacity Act is not used to detain people because provision in this country does not exist.
As the noble Baroness, Lady Bennett, pointed out, there are places, such as Trieste, where this issue has been dealt with starting from a different view: starting from what is needed, rather than this power being required because things are needed. That is the fundamental change that we need to make because, if not—I am glad the Government are moving down this path—we will continue to see people detained when they have not a mental illness or a psychiatric disorder but a development issue, which is not a psychiatric disorder. There are many papers on learning disabilities and autism by professionals who would argue that that is the case. We are all probing to try to work out what will happen.
I fully support the change to the detention criteria for autistic people and people with learning disabilities, and I believe it is key to reducing the number of autistic people and people with learning disabilities detained in mental health hospitals. But to achieve this policy intent, the Government need to make sure that a backdoor to detention is not opened through the inappropriate use of the Mental Capacity Act—detention in a mental health hospital under the deprivation of liberty safeguards instead. Without further guidance on the use of the Mental Capacity Act, the Government’s intent to reduce the number of autistic people and those with learning disabilities in mental health hospitals may be undermined.
I am concerned that the Mental Capacity Act may not be generally appropriate for use in deciding on treatment in a mental health hospital, as its primary intention is to help decide issues relating to people’s overall care and living arrangements. I am also concerned that somebody detained under the Mental Capacity Act would not benefit from procedural safeguards and access to the mental health tribunal if required.
Amendment 35 from the noble Baroness, Lady Murphy, would mean that people with a learning disability or autism could be held for six months. There could be a six-month period of detention but only in exceptional circumstances, which are not defined but are to be defined and put in the code of practice. Again, as we know, people can divert from the code of practice, so it is not the safeguard that the noble Baroness would suggest. Exceptional circumstances in a code of practice could be diverted from. Furthermore, based on the noble Baroness’s amendment, there could be a further six months for a tribunal to decide. Nowhere in here is there anything about therapeutic benefit and how that detention would be to the benefit of the individual rather than of society. So I am not clear how therapeutic benefit would be determined under the noble Baroness’s amendment.
Baroness Murphy (CB)
What does the noble Lord think will happen to the people in the gap?
Lord Scriven (LD)
As I said, the noble Baroness, Lady Bennett, pointed out what happens internationally, in Trieste in Italy, for example, and I therefore suggest that good international comparisons and practice could be enacted in legislation to ensure that the needs of as many people as possible are met in the community, rather than them being held in detention because the provision is not there. That is exactly what will happen unless this gap is dealt with by looking at what is required rather than looking at the gap and continuing detention.
Lord Hardie (CB)
My Lords, I apologise that I did not speak at Second Reading, but I have been listening to this interesting debate and it seems to me that Clause 5 is introducing the concept of detention in extreme cases, where there is a risk of serious harm to the health or safety of the patient or another person unless the patient is detained. That is the reason for the detention: to protect the patient from serious harm to himself or herself, or to protect others from serious harm.
As I read the amendment from the noble Baroness, Lady Browning, it simply seeks to suggest, or to put on the statute book, that someone suffering from autism or a learning disability would not satisfy the test in Clause 5. But the amendment permits the admission to hospital of someone with a learning disability for the purpose of assessing whether he or she has a mental disorder. I am not sure that this amendment by the noble Baroness, Lady Browning, would result in people slipping through the net.
Baroness Murphy (CB)
I wrote the amendment in a terrible hurry as a compromise amendment when I could not table the amendment that I really wished to table, which was seeking to get back to having clarity about the diagnostic criteria. I apologise if that was not the provision that the noble Lord wanted in the Bill—I am not sure that I want it very much either. I do not have any great devotion to the proposed new clause; it was just a way of trying to address this leaving of the gap. We used to do that, by the way. After the 1983 Act, noble Lords will remember that we dropped alcohol addictions and drug misuse from the Act, saying that we could not detain people for those reasons alone. What happened was that there was total neglect for the next 20 years until voluntary organisations and local authorities got moving and said, “This won’t do—we must do something”.
Noble Lords should remember that that is what happens. If you leave somebody out of protective legislation, they will not be included; they will be neglected and they will end up in prison. That is what Sir Simon Wessely thought and it is what the noble Baroness, Lady Berridge, has been talking about. I can guarantee that nobody will be interested in autistic meltdowns if there is no way in which to intervene to save a family from having that person with them, seven days a week and 24 hours a day, during the period of this terrible disturbance.
Community services are great. I urge noble Lords to visit Trieste, as it has brilliant services in a tiny area; it is one of the very few in Italy, and it continues to work very well. It is cited all over the world, and that is very good. But this is Britain, with 80 million people and massively underfunded services, and it ain’t going to happen. I want to know what will happen to those people noble Lords would like to see neglected until such time as the Government produce some alternative provision.
Lord Scriven (LD)
I do not think that I or anybody else who has a different opinion from the noble Baroness wants to see those people being neglected. We have a different view. The issue I have with her stance is that the evidence is that putting people with learning disabilities and autism in a psychiatric hospital—and that is where they will go if there is no provision, because that is where they go at present—is damaging. It is not the correct provision. I believe that what she is arguing for—to continue the neglect of provision by putting them somewhere—is significantly not in their best interests and causes damage.
Baroness Berridge (Con)
Perhaps I can clarify. I think that the noble Baroness’s amendment is to some extent based on the spirit of the Joint Committee’s report, which was about providing some kind of mechanism, after the 28 days—I am glad to see the noble Lord, Lord Bradley, nodding. There would be a specialist tribunal, and we said that it should be composed of people with experience of learning disabilities and autism, so that there was not a get-out for clinicians that they had not done the assessments properly. There would have to be grounded reasons to go beyond the 28 days and, in exceptional circumstances, you could authorise the detention, to make sure that the law covered that gap or group of people. No one wanted to see people detained for the reason that there was no community provision—that is ridiculous.
I accept that the reality is probably going to be that clinicians will find a mental disorder diagnosis to use the powers under Part II to do what is in the best interests of that person and their family at the time. But the law should also cover that situation and not force clinicians into those diagnoses—hence the need for accurate data, so that we can track what is happening when the law is enacted.
Lord Kamall (Con)
Once again, I am grateful to all noble Lords who spoke to this group of amendments. The purpose of today’s Committee is to probe the Government, but it is interesting that we find noble Lords probing each other—though I have learned a huge amount from these discussions. They say that discourse leads not only to liberty but to an increase in knowledge.
I add my words to those of the Minister and offer my condolences to the noble Baroness, Lady Hollins, who is not in her place today. I recall a debate in 2021 led by the noble Baroness—one of my first as Health Minister—in which she highlighted that people with learning difficulties and autism were being detained in secure settings, even when an assessment had recommended that they should live in the community. This goes back to the words of my noble friend Lady Berridge, who talked about how we can deal with the world as it is and not with the ideal world that we want to live in.
I was shocked at the time by what the noble Baroness, Lady Hollins, told the House about some of the findings from the oversight panel for the independent care (education) and treatment reviews. I bear in mind what the noble Baroness, Lady Bennett, said, when she gave some examples of other countries with much shorter detentions, but I will never forget the story that the noble Baroness, Lady Hollins, told about a Mr W, who had been detained in hospital for more than 20 years, spending most of his time in what amounted to solitary confinement. At the time of the debate, Mr W had been living in his own home for nearly three years, near his family, with his home environment and care being built around his needs. That is something that all noble Lords are trying to push for in this group of amendments. It was not only a heart-warming story but the point was made that, financially, it cost no more to support Mr W living in his own home than it did to detain him in hospital. More importantly, the noble Baroness shared the happy ending that, despite the trauma of being in the wrong environment for so many years, Mr W was, we hope, going to live happily ever after. That highlights the reasons for the amendments in this group.
I should add that I recall the noble Baroness who is now the Minister pushing the Government from these Benches on ending detention. I am sorry—I am going to be a little naughty here, but she can do it if we ever get back into government. She told the House that the average length of stay for people with a learning disability and/or autism in in-patient units was 5.4 years, saying:
“That is 5.4 years that no person will ever get back”.—[Official Report, 28/10/2021; col. GC 231.]
She asked how that could be justifiable when the cost of living in the community was the same as the cost of detention. I know that she is naturally sympathetic to ending these detentions. The detention of those with autism and learning disabilities was one of the central issues addressed by the Wessely review.
I was interested in Amendment 4, in the name of the noble Baroness, Lady Bennett, arguing the definition of “mental disorder” under the Bill. While I am sympathetic to the amendment, can the Minister confirm whether my understanding is correct that the World Health Organization defines a mental disorder as
“a clinically significant disturbance in an individual’s cognition, emotional regulation, or behaviour”,
and whether the WHO includes neurodevelopmental disorders, which includes autism? If so, are the Government sympathetic to Amendment 4 and considering bringing forward their own amendment? How would they avoid running contrary to the definition accepted by the WHO and included in the Diagnostic and Statistical Manual of Mental Disorders, particularly DSM-5? I understand the point that these things can change, as the noble Lords, Lord Stevens and Lord Scriven, have very importantly alluded to.
Amendment 5, in the name of my noble friend Lady Browning, seeks to ensure that, if a person has autism or a learning difficulty but not a mental health condition, we should not be using deprivation of liberty safeguards to replace detention under the Mental Health Act. We fully support my noble friend’s amendment and the intention behind it.
I am grateful to noble Lady, Baroness Murphy, who has tabled Amendment 35, for the time she has taken to share her experience and expertise with me and my noble friend Lord Howe. She addresses an issue that we should all be aware of with any legislation: that of unintended consequences. While most noble Lords here today would accept and support ending these detentions, for all the reasons that we have all given, and particularly after the harrowing stories that the noble Baroness, Lady Hollins, told all those years ago, how will the Government ensure that anyone with learning difficulties who could potentially pose a considerable risk in the community receive the required supervision? That is the challenge here, and it is the challenge to which my noble friend Lady Berridge referred when she reminded us that we have to talk about the world in which we live and not the ideal world that we all want.
I am very grateful to my noble friend Lady Berridge for sharing some of the deliberations of the pre-legislative Joint Committee, particularly on the issue of the High Court DoLS. Given that, and the point of the noble Lord, Lord Scriven, if we are to have alternatives, how do we prevent detention by the back door or opening a massive loophole for detention?
Amendment 39, from my noble friend Lady Browning, would ensure that detention was for needs associated with the degree of psychiatric disorder, along with Amendment 40. We are sympathetic to that, and I look forward to the Minister’s response.
Baroness Merron (Lab)
My Lords, I am most grateful to noble Lords across the Committee for their contributions. I will start by referring to the points raised by the noble Lord, Lord Scriven. A range of views has been expressed today on the matter of detention. The noble Lord asked what provision will be in place to ensure that we are not using some kind of backdoor, and that is a very good general question for us to hold in our heads. It is a very important matter, given the very poor outcomes we have seen for those with a learning disability and for autistic people under the current Act. I know this is something that has really exercised noble Lords—rightly so, in my view.
The noble Lord, Lord Kamall, is quite right to remind me of comments I made from that Dispatch Box, which I still stand by. I have concerns, as I know he does too. The proposals here are intended to address the matter of improving outcomes. The debate today has been extremely helpful and will allow me to reflect on where we need to go in respect of these. I am also grateful for the range of wider topics raised in this group—for example, on the importance of the community sector—and I look forward to moving on to these when we come to subsequent groups later today.
Let me first address Amendment 4 and the notice to oppose Schedule 1, tabled by the noble Baroness, Lady Bennett of Manor Castle. Currently, a person with a learning disability can be detained for treatment under Part II, Section 3 of the Mental Health Act when their learning disability
“is associated with abnormally aggressive or seriously irresponsible conduct”.
I heard what the noble Baronesses, Lady Browning and Lady Berridge, said. The noble Baroness, Lady Browning, used the word “meltdown”, and she has spoken to me about this before. I know that not all noble Lords like that word, which is why I put it in quotes, but the point is well made and the noble Baroness has explained to me about understanding a person’s conduct. It is also the case that an autistic person can be detained under Section 3 on the basis of mental disorder.
While the independent review found examples where use of the Act can deliver therapeutic benefit, it also found that hospital detention—a number of noble Lords spoke about this—can be detrimental for people with a learning disability and autistic people, due to exposure to environments or experiences that are completely insensitive to what I would call reasonable adjustments. This obviously causes stress and leads to behaviour considered to be challenging. We have heard that it is too often the case that people with a learning disability and autistic people are being inappropriately detained due to a crisis—which may be a better word in this instance—that has arisen due to a lack of community support, rather than for treatment of a mental health condition. That is unacceptable and the point has been extremely well made, both in the Chamber today and on earlier occasions.
The Government are committed to ensuring that hospital detention happens only when an individual has a mental disorder that warrants hospital treatment that has a reasonable prospect of providing a therapeutic benefit. It should not be some form of punishment. Schedule 1 and Clause 3 will change how the Act applies to people with a learning disability and autistic people by introducing new definitions for “psychiatric disorder”, “learning disability” and “autism” in the Act, and making amendments using those definitions throughout the Act. These amendments remove, for the purposes of Part II of the Act, learning disability and autism from the scope of conditions for which a person can be detained for compulsory treatment under Section 3. I hope that will be of reassurance to the noble Lord, Lord Kamall, and other noble Lords.
The noble Baroness, Lady Bennett, argued that the Bill is non-compliant with the UN Convention on the Rights of Persons with Disabilities. The measures in the Bill give patients greater choice, enhanced rights and support, and seek to ensure—I know that noble Lords want to probe this—that everyone is treated with dignity and respect throughout their treatment, and that the treatment is appropriate to the situation. It is the view of the Government that the Bill is compatible with the convention. Detention under the Act is not based merely on the existence of disability: that is something I really want to emphasise. Detention is risk-based. Detention and other compulsory measures are permitted only where they are justified by the risk posed by a person’s mental disorder and, through the Bill, I hope that we are very much strengthening the criteria for detention. We will come back to this later in Committee.
Amendment 4, tabled by the noble Baroness, would leave out Clause 3 and put in a new definition of mental disorder to remove learning disability and autism from the scope of the Mental Health Act entirely. This would mean that a person could not be dealt with under any section of the Act on the grounds of learning disability or autism alone. We very much recognise the arguments for removing these conditions from the scope of the Act, but there could be unintended consequences in the removal of critical safeguards. I know that the noble Baroness does not wish to cause that effect.
For example, the Bill retains the ability to detain people under Part II, Section 2, for a maximum of 28 days, for the purpose of assessment. That can be necessary both for the safety of the individual and the public, and for a clinician to understand fully whether a treatable mental health condition is the cause of the behaviour. I suggest that this is particularly important when considering conditions associated with high rates of co-occurring mental health conditions. Without these powers, there is a risk that the mental health needs of these groups of people are not identified or met appropriately, leading to further health inequalities for this group of people. I know that is not something that noble Lords would wish.
Baroness Barker (LD)
I have not spoken in this debate so far, but I have listened intently to everything that everybody has said, including the noble Baroness, Lady Murphy. Members of the Select Committee will remember—they could not forget—the evidence given to us by particular witnesses who have autism and have been through the trauma of being detained. They made to us, unforgettably, the point that there are some people with autism and learning disabilities for whom detention is an aggravating factor.
I happen not to agree completely with the noble Baroness, Lady Bennett, that there should be an end to all detention, although I have some sympathy with her arguments. I believe there are people for whom detention is necessary—both for them and for the safety of others—but they should be held in mental health facilities and not the criminal justice system.
I listened intently to the noble Baroness, Lady Murphy. I understand that it may be absolutely correct to define people with autism and learning disabilities as having a disorder, but we have moved on over 20 or 30 years to understanding that their manifestations and treatment are different from those of other mental health conditions. There is therefore a problem in having the diagnosis and treatment carried out by the same people. I hoped that she would explain, but she did not, why keeping people within the definition would improve their care.
Baroness Murphy (CB)
Does the noble Baroness accept that, in talking about treatment, we are talking about care, education and training in social circumstances? Treatment is not about medication, which may be totally inappropriate, but about looking at the individual’s developmental needs as a whole, which include a whole raft of things. I agree that it is not just about psychiatrists or psychologists; it can be about teachers, people with a special understanding of speech and language, and so on. I would never deny that you have to encompass the whole thing—I would promote it.
Baroness Barker (LD)
I am sure that the noble Baroness would. Does she accept that for some people, particularly those with autism and learning disabilities, being held in conditions that are noisy, filled with light and full of people they do not know—in which they are made to feel completely powerless and do not know what will happen to them next—will be a contributory factor to their illness? I make that point to the noble Baroness, Lady Merron. She talks about choice, but what increased protections are there in this Bill for people with autism or learning disabilities who find themselves in detention, which is an aggravating factor causing them to be wrongly diagnosed?
Baroness Merron (Lab)
I will be pleased to come back to that point. I think agreement broke out for a moment, which I would share, on the fact that detention takes many forms. It is about getting the right form and being sensitive to the needs of the individual, which is what the Bill is all about. I am grateful for those comments.
To pick up my point about the expert consultation that has taken place, a decision was taken to retain the ability to divert people who are autistic or have a learning disability, who have committed a crime, from prison to hospital under Part III of the Act. Without this safeguard, the only alternative to detention in hospital is detention in prison. Noble Lords have referred in this group to how, often, this would be inappropriate in meeting those people’s needs and would exacerbate and manifest distress. On balance, we believe it is right to retain the ability to divert such patients to hospital, where they are much more likely to access the right kind of support and care that they need.
The noble Baroness, Lady Bennett, raised concern about resourcing implications for local authorities. I refer her to the impact assessment, which sets out anticipated costs, including a breakdown of costs for councils. I assure her that we will do further work with MHCLG to assess any new burdens on local authorities created by the Bill. We are very alive to that situation.
Baroness Browning (Con)
The Minister will not be surprised to hear that I like what she just said. Is there no way she can put that in the Bill under a government amendment?
Baroness Merron (Lab)
I am grateful for the invitation, as always. Government amendments will be considered as we progress through Committee, but I say that as a broad point, as I know the noble Baroness understands.
The intention of the provisions in the Bill on registers and commissioning is that people with a learning disability and autistic people are not detained but supported in the right way. The proposed changes to Part II, Section 3 will be commenced only where there are strong community services in place.
Baroness Berridge (Con)
I am aware of how much time the Minister has given and how generous she has been in allowing interventions. If she is minded on Amendment 5, can she outline whether she is proposing that there would be the special tribunal that the Joint Committee outlined? If so, how would she then deal with these issues for under-16s in respect of DoLS and for vulnerable adults? When there is no legal basis at all, it is then left for clinicians to detain anybody after the 28 days.
Baroness Merron (Lab)
I became a little worried, listening to the noble Baroness, Lady Berridge, that perhaps I had been a bit too generous.
Baroness Merron (Lab)
I am sure that I have not been generous enough. I cannot give a commitment to government amendments on any of these areas. As noble Lords will be aware, that is the purpose of the kind of debate that we are having in Committee. However, we will certainly return to these matters.
The Mental Capacity Act protects people subject to arrangements that may amount to a deprivation of liberty in hospitals, care homes and other settings, by allowing a deprivation of liberty only when it is necessary and proportionate. There are instances when it is important that the Mental Capacity Act can be used to protect and to safeguard people where appropriate, and we do not want to lose that aspect.
The concern about the amendment is that it might have the effect of undermining decision-making, or of denying a specified group of people the right to protections under the Mental Capacity Act—although I know that this is not intended. I will give an example. Where a person lacks capacity but does not have a psychiatric disorder that requires treatment, there may be elements of that person’s care plan and arrangements that require deprivation of liberty safeguards to ensure that they can access the community safely and maintain a safe home environment. Similarly, certain specialist community placements are also registered hospitals, so the proposed amendment could unintentionally—I stress “unintentionally”—remove such provision as a viable community-based option, where the individual lacks capacity but would benefit from this placement as an alternative to in-patient care.
The noble Baroness, Lady Berridge, rightly made some comments about the statistics for LDA detention rates. I assure your Lordships that the data and statistics being referred to are absolutely key. They are collected and published, and they will continue to be monitored. If there are any matters where the noble Baroness or other noble Lords feel that we should go further, I would be very pleased to receive their comments.
On the point raised by the noble Baroness, Lady Berridge, about the use of High Court deprivation of liberty safeguards for children, I will refer to the action of the previous Government, which I hope will be seen as very helpful. In 2023, a task and finish group was established called “Improving cross-sector support for children in complex situations with multiple needs”. It was made up of a number of central government departments, operational local agencies and representative bodies, the NHSE and the Youth Custody Service to represent the voice of children and young people, as well as the Children’s Commissioner. This group has been developing a cross-sector response to help ensure that there is suitable provision in place for children and young people with complex needs who are at risk of being deprived of their liberty. To that point, I will take a particular interest in the task and finish group and its work, and we may come back to it.
Baroness Barker (LD)
I thank the Minister for giving way again. Listening to the noble Baroness, Lady Browning, set out and explain her amendments, it seems to me that they require the people making the decisions about whether to detain somebody to be clearer about which law they are using to decide to detain at a particular point for a particular person. As I understand it, they are not excluding or preventing the use of either bit of legislation for an individual; they seek just to have greater clarity about which legislation is being used and why, and therefore what protections the person will have. The Minister said that, if these amendments go through, some people will, somehow, be excluded from the correct treatment. Is there a particular group of patients or conditions that are at risk if the amendments tabled by the noble Baroness, Lady Browning, are implemented? Can the Minister give us some examples? Otherwise, I fail to see the logic of what she is saying, given the explanation that the noble Baroness, Lady Browning, gave the Committee.
Baroness Browning (Con)
I agree. The amendment seeks to strengthen and to clarify, rather than to make changes that would be completely different to what is intended in the Mental Capacity Act.
Baroness Merron (Lab)
I am grateful for the noble Baronesses’ comments. I will come back with some examples before I sit down, because that is a very good suggestion. If I fail to do so, I will gladly provide them in writing.
Amendment 35, tabled by the noble Baroness, Lady Murphy, intends to provide a route to detain people with a learning disability and autistic people who do not have a diagnosed psychiatric disorder. Detention could be authorised only with the approval of the tribunal in “exceptional circumstances”, with power to provide guidance on what those circumstances will be in the code of practice. The amendment seeks to address the needs of those with a learning disability and autistic people, with whom I know the noble Baroness is concerned, where a considerable risk is being posed in the community, but who do not also have a diagnosed psychiatric disorder warranting detention for treatment under Part II, Section 3.
Our clear intent throughout the Bill is that people should be detained beyond Section 2 only when they have a psychiatric disorder that requires hospital treatment. It is our feeling that this amendment runs contrary to that intent. I am also grateful to the noble and learned Lord, Lord Hardie, for his comments on Amendment 35.
We also have some concerns about the scope of the “exceptional circumstances”, which would potentially result in a position no different to the current effect of the Act. It is unclear, in advance of the code of practice being developed, how broadly this might be defined. There would be considerable scope for different, divergent approaches in comparable cases, which, again, I know is not the intent of noble Lords.
Baroness Merron (Lab)
I am sure that the noble and learned Baroness’s yawn speaks for many.
Baroness Merron (Lab)
There is no need to apologise.
I am pleased to provide the reassurance that the proposed changes to the Section 3 detention criteria mean that it would no longer be possible to detain someone with a learning disability or an autistic person under Section 3, unless they have a psychiatric disorder. Additionally, the Act already requires a statement of rationale for detention and statutory forms. The registered medical practitioner will have to confirm that the patient meets the criteria for detention, including that they are suffering from a psychiatric disorder requiring hospital treatment and not just that the patient has a learning disability or is autistic. I hope that will be of reassurance to the noble Baroness.
For the reasons I have set out in respect of all the amendments—I thank noble Lords for them—I ask the noble Baroness to withdraw hers.
Baroness Bennett of Manor Castle (GP)
I thank the Minister for her rich and full response, and indeed all noble Lords who have taken part in this important debate. It has been long but that has been quite necessary. I thank the Minister particularly for responding directly to my question about the UN Convention on the Rights of Persons with Disabilities. I do not agree with her response but I appreciate that she engaged fully with it, so I thank her for that.
I will not go through and summarise all the contributions, but I just want to make two points, which are perhaps specifically directed to the noble Lord, Lord Kamall, and the noble Baroness, Lady Murphy. A phrase which has been missing from our whole debate is the “social model of disability”. That is the idea that society is discriminatory, and that people are disabled by the barriers in society, not by their difference. That position was endorsed by the Government Equalities Office in 2014, and so far as I know, that still holds, and it is preferred by most disability charities.
I invite noble Lords to consider another phrase in this healthcare space, which is “parity of esteem”. I think that when we come to the social model of disability and physical disabilities, most people have now accepted that if there are only steps and not a ramp, that is a failure of society, not the failure of the person in the wheelchair. However, we have not heard in this debate an acknowledgement of the same parity of esteem—the same approach to mental disability as we have accepted towards physical disability—and we should consider and think about that.
In that context, just to pick up a couple of points from the Minister, she talked about how people with autism or learning difficulties can be detained for aggressive or irresponsible conduct. The Trieste model—if I can call it that—which is being adopted by many countries around the world, asks: “Can we intervene before that point and ask what has provoked that person? Can we intervene before we need to detain someone?” That needs to be very carefully considered.
The other point that the Minister addressed, which I confronted myself with, asking why I did not table the broader amendment that I might have done, is what happens when people get to the point of being a danger to themselves or—I stress that this is extraordinarily rare—a danger to others as a result of a mental disorder. Again, how did people get to that point, and should there not be services and support and community wraparound in the Trieste style? I do not think that any nation or area is saying that it has totally got to that point, but surely we should be aiming at that.
Lord Kamall (Con)
The noble Baroness referred to the Trieste model, and I thought that led to quite a deal of interest from noble Lords across the House. Could she share some details on the Trieste model with other noble Lords but especially the Minister and the department, so we can all start learning those lessons?
Baroness Bennett of Manor Castle (GP)
I should absolutely stress at this point that I am not an expert, but I will certainly do my best to secure as much information as possible and share it with all noble Lords. The Minister may also have access to resources that may not be available to me. Reflecting on the intervention of the noble Lord, Lord Kamall, perhaps we could even arrange some kind of discussion—it might be useful—and perhaps even hear some testimony, because that would really inform our consideration of the Bill. But in the meantime, I beg leave to withdraw the amendment.
Baroness Barker
“(iv) housing”Member’s explanatory statement
This amendment ensures that housing needs are considered as part of care, education and treatment review meetings.
Baroness Barker (LD)
My Lords, since this is the first time during our proceedings that I propose something, I declare an interest as a member of an advisory panel for Rethink Mental Illness in an unpaid capacity.
I apologise if I risk sounding like a broken record; it is just that I have been here discussing these issues so many times in the past, as indeed have many other Members of your Lordships’ House. I will not apologise for taking a long-term view of things or for saying that there have been areas of change and areas of progress. But I also do not apologise for explaining to your Lordships the amount of effort and discussion that it has taken to bring about change and movement, not least against some of the entrenched views of the professions, which over the years have put up quite a deal of resistance to change.
It is also our job to look at the proposals that have come forward from patients’ groups and say that some of them are valid and some of them are not. We are in a unique and very privileged position in this House where we get to take a long-term and wide perspective, and we should use it wisely.
I say that because we have debated care and treatment plans time and again. Mental health institutions up and down the country are littered with files of care and treatment plans, many of which have sat on shelves and never been implemented. With this legislation, we are moving to the position we need to get to where everybody who is subject to mental health treatment has a care and treatment plan, the decision-making behind that plan is open to scrutiny, and the people responsible for delivering it are held accountable.
I cannot imagine what it must be like to sit day after day in a place where I know I am supposed to be given treatment that will enable me to get better and get out, and to receive nothing. I imagine the temptation to sit there and think about that all day long is in itself is a gravely depressing factor. That is the sort of thing that we have listened to over the years from people—particularly young people—who have been subject to mental health treatment and care plans and never had them delivered, so how pleased we are to have moved forward to this point. I am also very pleased that Members are trying to take this opportunity to beef these plans up, in particular the accountability around the delivery or failure to deliver them.
I want to include housing in the Bill. You do not have to have a mental health condition to be severely worried about housing these days. Any young person in this country can have real concern about availability of housing, tenure and all the rest of it. If you have a mental health condition and are likely to be detained for an indefinite period, and therefore very likely to lose your tenancy or whatever, that must be a huge aggravating factor.
One reason why I was prompted to table this amendment was because I was on the pre-legislative scrutiny committee for the then Bill back in 2006. Somewhere there is an unwritten law that, when mental health legislation is coming up, Members of this place will be sent to the South London and Maudsley. There is no way out; you have to go. But it is always good to go to SLaM to talk to the staff, who are immensely generous with their time. You cannot go on one of those visits and walk out unchanged from the experience.
I remember, in particular, a bunch of your Lordships going to talk to one of the best teams that I have seen in practice. Back in those days they were called an assertive outreach team; I do not know what they are called these days. They were absolutely brilliant, dedicated individuals. Their job was to work with people out in the community, to know them all and to predict the problems that would arise. One thing I remember them telling us was that they would frequently go to the local authority or to landlords when they had somebody whose particular crisis was that they had got into arrears. They would head it off by negotiating and de-escalating the situation so that the person did not get turfed out and therefore end up in acute care.
Similarly, we know that discharge is a lottery for anybody who goes into any acute hospital for any reason at all. Discharge from the NHS is one of those things that when it goes brilliantly, it goes brilliantly. When it does not, it is an absolute and utter disaster, and the person at the centre of it has absolutely no control over it at all—even less, I would suggest, when they are being discharged from mental health treatment.
Lord Scriven (LD)
My Lords, I shall speak my Amendments 8, 11, 15, 18, 19 and 20 in this group. They are to do what my noble friend Lady Barker said: to try to beef up the care (education) and treatment reviews, because something is amiss. As my noble friend said, too many of them are sitting on stuffy and dusty shelves, and not enough people get access to them to be able to advocate for and follow through on them.
Amendments 8 and 15 are important regarding the people who are legally entitled to receive a copy of the care (education) and treatment review. I support the amendment from the noble and learned Baroness, Lady Butler-Sloss, to add the parent and guardian, which was an omission. Currently, the Bill provides for a copy to be sent only to the responsible commissioner, the patient’s responsible clinician, the ICB and the local authority. To ensure that the patient and their family, carer and advocates are fully aware and informed of the decisions being made around their care, can hold services to account and can follow up on the care and treatment plan recommendations, it is essential that they too receive a copy of the report.
These amendments would ensure that the patient, the patient’s nominated person and the patient’s independent mental health advocate receive a copy of the care and treatment report. I note that the Minister has tabled an amendment setting out that a copy of the report “may” be given to other persons, but this does not place a strong enough duty to involve the patient and significant others to ensure that adequate oversight of the care and treatment review reports is available to them.
Amendments 11 and 18 reduce the maximum time between the reviews from 12 months to six months for adults and children. This is in line with the recommendation of the Joint Committee on the Draft Mental Health Bill. According to NHSE data, 24% of autistic people and people with learning disabilities detained in mental health hospitals have been waiting for more than one year for a CETR or have no CETR at all, and 31% have had the date of their next scheduled CETR pass or have no scheduled CETR at all.
We know that autistic people and people with learning disabilities face lengthy stays. There must be a drive to discharge these people. The idea that we would have a CETR only every 12 months to help prevent a lengthy stay shows how worryingly normalised long lengths of stays have become for these individuals. In many cases, a maximum interval of 12 months may be too long and mean that autistic people and people with learning disabilities face delays to their discharge planning. The current frequency of CETRs in the Bill is not in line with NHS England’s policy, which states that, for adults, CETRs should be held at a maximum frequency of six months.
Amendments 19 and 20 seek to ensure that the recommendations of CETRs are followed through. This is essential to ensuring that the needs of individuals are being met and that steps are being taken to prepare for their discharge. Often, the recommendations arising from CETRs are constructive, and those attending may leave with the impression that the right steps are being taken. However, the frequent failure to carry out the recommendations arising from these reports undermines faith in the process and can lead to unnecessary delays in an individual’s needs being met and in their discharge.
CETRs, which are essential to providing safeguards for autistic people and people with learning disabilities under the Bill, are important. Their being undermined cannot be allowed. The current language in the Bill for the responsible clinicians, commissioners, integrated care boards and local authorities says that they must “have regard” to the recommendations. I believe that this is too weak. Legally, the definition of “regard” is that a public body must consider something and, once it has been considered, has discretion to carry out or ignore it. A duty in law is an obligation and must be followed, and the reason why it has been followed must be given. These amendments would substitute “regard”—the weaker definition—for “a duty” to carry out these actions unless a compelling reason is provided for why this is not possible. This follows a similar recommendation from the Joint Committee on the Mental Health Bill, which stated that ICBs and local authorities should be required to “follow” recommendations in reports—that is, have a duty.
Baroness Butler-Sloss (CB)
My Lords, I should like to speak to Amendment 9, following on from the noble Lord, Lord Scriven, on Amendment 8.
We are dealing with the responsible commissioner making arrangements for the care (education) and treatment review meetings and the report. I do not know whether I am a lone voice speaking in this House but I am a mother and a grandmother, and there is not a single word in any part of this Bill about parents or guardians—not a word. I could find references to parental responsibility only in new Schedule A1 and Schedule 2, although I may be wrong.
Can I just suggest something to noble Lords? Where you have a child—here, I am dealing specifically with a child—with autism or physical or mental disabilities, it is quite probable, if not most likely, that that person will be living with their family and their parents. I must say, my experience as a family judge led me to believe that only about 5% to 10% of parents who came through the courts were not suitable to look after their children full time. But according to Clause 4—which inserts new Section 125A—the one group of people who will not be told what the future care (education) and treatment review given to their child will be includes the people with whom that child has been living for all their life. I cannot understand why this Bill seems to think that parents, guardians and other people with parental responsibility do not matter. That is why I have raised this issue. I feel intensely strongly about it, as a mother and a grandmother.
Baroness Bennett of Manor Castle (GP)
My Lords, I shall speak very briefly, having attached my name to Amendments 19 and 20. I support all of the previous amendments, which are in essence about people knowing about care and treatment review plans. I particularly wanted to sign these two amendments because of the clause identified by the noble Lord, Lord Scriven, and the noble Baroness, Lady Hollins. It states that integrated care boards and local authorities “must have regard to” the plan—as the noble Lord outlined, that is a very weak, weaselly form of words—rather than having a duty to deliver the plan that has been established for the well-being and health of a person. The phrase in the Bill now really is not adequate.
I want to share something with noble Lords. On Friday night, I was in Chorley, in Greater Manchester, at a meeting with the local Green Party and NHS campaigners. One of the things I heard there was a huge amount of distrust and concern about integrated care boards and the restructuring arrangements that have happened with the NHS. I am not going to get into those issues now but, with the words “must have regard to”, we are leaving an open door and a door to distrust. Surely the right thing is for this Bill to say that the ICB has a duty to deliver a care plan.
On Amendment 20, we will undoubtedly talk endlessly about resources, but that there must be a compelling reason is the right terminology to have in the Bill; it really has to be justified. I believe that both of these amendments should be in the Bill.
Baroness Tyler of Enfield (LD)
My Lords, I will speak to Amendment 13 in my name in this group, but wish to add my support to the amendments that have already been talked about: those in the names of my noble friends Lady Barker and Lord Scriven, and the very important amendment in the name of the noble and learned Baroness, Lady Butler-Sloss. I have experience in my wider family of someone with autism, so I know full well the importance of having the parents and the wider family involved in review meetings. Frankly, it would be very difficult indeed if they were not there for those review meetings to express the wishes and preferences of the individual concerned.
I guess that that is quite a helpful link to my amendment, which is about communication needs. I know that we explored this issue pretty thoroughly in our debate on the first group—you could argue that my amendment could have been in either the first grouping or this grouping, but it is in this grouping. I will keep it short, because we have talked about this quite a lot. In essence, the amendment is designed to ensure that communication needs being met is included on the list of the subject matter that must be considered and on which recommendations must be made during the care (education) and treatment review meetings.
It is clearly vital, as we have all acknowledged, that every effort is made to ensure that autistic people and people with learning disabilities are involved in their own care and treatment decisions and are able—this is the critical point—to express their preferences and needs. To ensure that this is the case, their communication needs must be understood, considered and met; the noble Lord, Lord Kamall, made that point powerfully in our debate on the first group. Often, this needs to include understanding a person’s communications preferences; having the right sort of environment; making sure that the environment is supportive; or, sometimes, using very specific communication tools, which do exist. This can also include—this refers to the amendments from the noble and learned Baroness, Lady Butler-Sloss—the involvement of a person who knows and understands the patient well, quite often a family member or advocate. That can be key to meeting someone’s communications needs.
I am sure we all agree that care and treatment reviews need to be designed to ensure that the person affected is central to the decisions being made about their care and treatment. It is therefore absolutely self-evident that communications needs should be considered and discussed at the beginning of those meeting to ensure that the person concerned is able to express their thoughts, wishes, feelings and preferences, so that everyone involved in the care and treatment of individuals is equipped to meet those moving forward.
I am very supportive of the amendment tabled by my noble friend Lord Scriven which would lengthen the time between reviews from 12 months to six months. I think 12 months is just too long. An awful lot can happen in that period and circumstances can change. I know that we have a subsequent group on care and treatment plans, but on the point made by my noble friend Lady Barker, it is important to think of the individual in a fully joined-up way, looking at housing needs as well. I know that we are going to return to it in a subsequent group, but it vitally needs to include things such as money matters, debt advice, ensuring that the individual does not fall into financial exclusion and all of that. I have put my name to an amendment on that in a later group.
Baroness Watkins of Tavistock (CB)
My Lords, I support the amendment in the name of the noble Baroness, Lady Barker, with relation to housing. I do not want to go back 20 years for any reason except to say that, when we were closing the vast majority of mental health in-patient beds, the main aim of many of us doing those change programmes was to ensure that people had somewhere to live when they had been living in hospital for 10, 20 or, in some cases, 30 years, and that the housing had to be appropriate to their level of ability. Spending 30 years in a hospital does not exactly teach you self-reliance. There are some real challenges about that, so housing must be considered in any discharge planning.
On Amendments 19 and 20, the noble Baroness, Lady Hollins, has sent me a copy of her speeches in her absence. Like others, I think that it shows her commitment to this House that at this point in her life she is trying to make sure that her voice is heard. I add my condolences to those of others in the Committee. Her point is that you would not discharge people from acute hospital without some proper care and treatment plan. I want to use my own words rather than hers, but when you say that somebody needs dialysis or that they need regular checking of their heart monitor, we automatically do it. Elective care is still getting a huge amount of focus, but elective care in this country is defined as acute hospital care, not elective care for mental health patients and people with learning disabilities. I want to rest it there, but that is why I support Amendments 19 and 20 so strongly.
Lord Stevens of Birmingham (CB)
I too am supportive of the spirit and intention behind Amendments 19 and 20, but I want to raise two textual questions relating to whether they would give effect as was intended.
In respect of Amendment 19, I am not sure that the explanatory statement accurately characterises what the amendment proposes. It says that the amendment ensures that ICBs and local authorities would
“have a duty to carry out”,
whereas at the point at which those words would be inserted it appears that the duty would also then fall to the patient’s responsible clinician. Amendment 19 by itself would essentially see CETRs overriding the judgment of the responsible clinician, which I think is quite a significant step to take.
In any event, I wonder whether Amendment 20 undoes any of the good work that Amendment 19 proposes in the first place. It says that you can ignore the exhortations of Amendment 19 if there is a “compelling reason” to do so. My question to the drafters of Amendment 20 would be: what statutory interpretation should be placed on “compelling reason” and how might the courts be expected to adjudicate in the event of judicial review?
Lord Bradley (Lab)
I support and have added my name to Amendment 13, tabled by the noble Baroness, Lady Tyler, around communication issues. As she rightly pointed out, this could have been linked to Amendment 2, which has already been debated at some length. I will not repeat the same arguments, but they apply to this amendment, which is why I support it.
I also very strongly support the amendment on housing tabled by the noble Baroness, Lady Barker. I am chair of NHS England’s health and justice advisory board and have worked on the development of RECONNECT, the service to support people coming out of prison back into the community, which is very much a health-based initiative. Unless their housing needs are met at that point, their treatment, their support and their care plan can fall apart very quickly. Consequently, they are very quickly back in the criminal justice system. The same comparison can be made with this amendment. I strongly support housing being at the core of all issues relating to health and social care.
Baroness Berridge (Con)
My Lords, I rise to support the noble and learned Baroness, Lady Butler-Sloss, on Amendment 9. I know that there are other amendments in relation to the inclusion of parents and guardians. I raise just two small points in relation to this.
When one looks at where this amendment is inserted in the list, the last of the persons currently listed who would receive the report is
“the local authority in whose area the patient is ordinarily resident”.
That potentially will not always be the local authority where there is a care order. Therefore, in those circumstances, the local authority is caught with an
“other person who has parental responsibility”.
However, that is not how this is drafted in other parts of the Bill, where an
“other person who has parental responsibilities”
means guardians et cetera. For consistency of drafting, we need to look at that.
I know that the Minister has been very generous in the time that we have had with her and her officials, but we need a consistent phraseology within the Bill because with this amendment, if there was a special guardian the report would also go to the person with what is informally known as residual parental responsibility. Normally they are informed only, for instance, of the change of name of the child or if the child is going to leave the jurisdiction. We need to look at everybody with parental responsibility and have some consistent phraseology within the Bill when we are meaning the local authority when there is a care order and parental responsibility, to include all the different circumstances in which a child may have their status changed from the ordinary situation of living at home with parents when a court order is in place.
The Earl of Effingham (Con)
My Lords, this group of amendments aim to strengthen provisions for care (education) and treatment reviews—CETRs, as we have heard—for individuals with autism or a learning disability. These amendments collectively aim to address gaps in the current drafting and ensure that the needs and rights of these individuals are fully considered and respected.
This reflects the dignity, respect and patient-centred care principles that strengthen the Bill. Amendments 6 and 12, in the name of the noble Baroness, Lady Barker, highlight the importance of considering housing needs during care (education) and treatment review meetings. A stable, safe and appropriate home environment is a critical determinant of mental health and well-being. Failure to address housing can undermine the effectiveness of care plans, leading to avoidable crises, as the Minister put it earlier, and setbacks that can risk damaging the long-term success of these care plans. Can the Minister please clarify how housing needs will be integrated into the CETRs under the current provisions of the Bill?
Amendments 8 to 10 and 15 to 17 focus on ensuring that the CETR process is inclusive and transparent. These amendments expand the list of those who should receive CETR reports to include the patient, their nominated person, independent mental health advocates and, where relevant, their parent or guardian. These measures should help foster trust and collaboration in the care process and create a more holistic approach to care planning by ensuring that all key individuals are kept informed. Can the Minister please confirm whether the current drafting of Clause 4 sufficiently addresses these inclusivity concerns or whether these amendments are necessary to achieve that goal?
Amendments 19 and 20 address the issue of ensuring that recommendations from CETRs are acted upon. It is not enough for reviews to generate reports and recommendations: there must be a clear and enforceable duty on integrated care boards and local authorities to act on them. Amendment 19 would strengthen this by replacing the current requirement to “have regard to” recommendations with a “duty” to carry them out; while Amendment 20 ensures that “a compelling reason” must justify any deviation from these recommendations.
These amendments reflect the frustration often experienced by patients and families when well-intentioned recommendations are not implemented. A stronger duty to implement recommendations would not only improve outcomes but restore trust in the system. Can the Minister outline how the Government intend to ensure that recommendations from CETRs are indeed implemented effectively?
Amendment 13 highlights the importance of addressing communication needs during the CETR meetings. It is highly welcome that the issue of communication and language has been addressed by so many noble Lords. Effective communication is essential for patient-centred care, ensuring that patients can meaningfully participate in that very care. Ensuring that individuals’ additional or alternative communication needs are met is not merely a courtesy, it is a necessity and a must-have. This group of amendments highlights the importance of a holistic, inclusive and accountable approach to care and treatment reviews. They seek to ensure that the needs of patients, including those related to housing, communication or support networks, are fully recognised and addressed. They also emphasise the need for timely reviews and actionable recommendations backed by clear accountability mechanisms.
His Majesty’s Official Opposition are broadly supportive of the aims of these amendments, and we look forward to the response from the Minister.
Baroness Merron (Lab)
My Lords, I am grateful to noble Lords for their amendments and contributions today. It seems a while ago that the noble Baroness, Lady Barker, originally spoke, but I put on record that I hear her frustration about having been here before. I certainly acknowledge that; and I am grateful for the contribution and time that noble Lords have given to this really important matter, so that perhaps, finally, we will not have to keep going where we have been before.
Baroness Butler-Sloss (CB)
I entirely understand what the Minister has just said, although I do not agree with her, but the point she made about other persons is not contained in the clause that I was complaining about.
Baroness Merron (Lab)
I am grateful to the noble and learned Baroness for making that point, and I will gladly review this in the light of it.
To return to the specific amendments, they would ensure that the patient, the patient’s nominated person, the independent mental health advocate and the parent, guardian or other person with parental responsibility receive in all cases a copy of the report following a care and treatment review meeting—or a care (education) and treatment review meeting for children and young people. The current drafting of the Bill is intended to make clear that a copy of the review report must be provided to those who have a legal duty to have regard to the review recommendations, so that any recommendations are implemented as appropriate.
We recognise that there may be individual circumstances that mean it is appropriate for the report to be provided to other people, including the patient themselves. For children and young people, this report is most likely to be shared with a parent, guardian or other person with parental responsibility, but it is important that the legislation does not inadvertently create a legal requirement that must be complied with, which would not be appropriate for every person.
A longer list of people with whom the report must be shared, in every case, may increase the chance of an individual withdrawing the consent for a review to be held if they do not wish for some or all the people to see the report. There may also be circumstances in which the report should reasonably be shared with other people in addition to those set out in the amendments—for example, a family member who has been part of the review process with the patient’s consent but is not the patient’s nominated person or someone with parental responsibility.
We have tabled a government amendment to make it clear that the arrangements may include provision authorising or requiring a copy of the report to be given to other persons, so that the patient may also ask that a copy be provided to others or decide to provide it to others. Statutory guidance will help assist the responsible commissioner when exercising its functions, including when considering other persons who are to receive the report. We wish to allow flexibility for this, so that individual circumstances can be taken into account based on the needs of the patient and their wishes, rather than by providing a prescriptive list of people to whom the report is to be sent in every circumstance.
Lord Scriven (LD)
For clarification, is the Minister therefore saying that the Government’s amendment will lead to some statutory instrument, or will it be just at the discretion of the Minister to determine a list and change it without any scrutiny?
Baroness Merron (Lab)
I am approaching this without going down the amendments’ route of having a fully prescriptive list, which might have unintended consequences.
Lord Scriven (LD)
I really need to understand the intent of the Minister’s Amendment 17
“authorising … a copy of the report to be given to other persons”.
How do the Government intend to draw up that list, to change it and to make it public, so that people know that they are appropriate persons and might be able to get the report?
Baroness Merron (Lab)
I hope it helps to advise that the responsible commissioner will be key to all that. I emphasise the need to design around the patient and their needs. If there are further points that I need to look at on this, I would be very pleased to. I am grateful to the noble Lord for raising it.
Amendments 10 and 17 are technical and minor government amendments that make it clear, for the avoidance of doubt, that the responsible commissioner may make arrangements for a care and treatment review report—or a care (education) and treatment review report for children and young people—to be provided to persons other than those listed in the clause. They could, for example, be those who have an interest in the recommendations because they are involved in the review process, such as an independent mental health advocate, a nominated person or a professional involved in the patient’s care and treatment. This would be subject to the patient’s consent. We believe that this is important to clarify, since the review process is likely to involve more people than those who are listed in the legislation, although this will vary according to the individual and their needs and circumstances.
In addition, the Bill makes specific provision to clarify which persons and bodies are to receive the report in every case to ensure that they can comply with their duty to have regard to the review recommendations. I hope that these government amendments find favour with noble Lords.
Amendments 11 and 18 were tabled by the noble Lord, Lord Scriven, who raised the point that around a third of people have no CETR or CTR. My response is perhaps to provide the assurance that that is exactly why we are putting them on a statutory basis. It seems that Amendments 11 and 18 are intended to reduce the maximum amount of time between CTRs for adults and CETRs for children and young people from 12 months to six months following a patient’s initial review meeting. These amendments would apply to children and adults.
I listened closely, as I have listened closely to all comments from noble Lords, but we believe that these amendments are somewhat unnecessary. Current drafting provides that review meetings take place at least once in a 12-month period, in line with the maximum timeframe within NHS England’s policy and guidance. This is in addition to the requirement that arrangements must be made for everyone to have a review promptly upon admission, within 14 days for children and 28 days for adults. Commissioners should use their judgment to determine the frequency of subsequent reviews, in line with the specific needs of the patient. Patients, their families and advocates can also request a review meeting at any point.
There will be statutory guidance to provide commissioners with further information on factors to consider when determining whether more frequent reviews should take place. I understand the noble Lord’s point, but I hope that helps. For example, it is current practice that children under 18 have a review meeting every three months, and this would be articulated in the guidance. We consider it preferable to set out this information in statutory guidance, which can provide detailed case studies. That would not be possible if we set it out in the same way as primary legislation, not least because guidance can be readily updated in line with emerging best practice, including on frequency and considering particular circumstances.
Lord Scriven (LD)
I have listened very carefully to the Minister about flexibility. Why is 12 months in the Bill? All I am trying to do is to change a statutory timeframe that the Government have put in the Bill to six months. That flexibility is not there because 12 months is in the Bill. I am trying to move that fixed point from 12 months to six months, regardless of what guidance says.
Baroness Merron (Lab)
Yes, I understand the intention, but I refer back, perhaps usefully, to the point I made earlier that review meetings would take place at least once in a 12-month period; it is not a maximum—I think I have got it the right way round. It will be at least once in a 12-month period; it is not that it can be only once in a 12-month period. That is, as I said, in line with the maximum timeframe in NHS England’s policy and guidance.
Amendment 13 tabled by the noble Baroness, Lady Tyler, relates to care and treatment reviews. The amendment seeks to ensure that a patient’s review makes recommendations about ensuring communication needs are met where there are additional or alternative communication needs. That is something we discussed very constructively in the first group and it was referred to by the noble Earl, Lord Effingham. We believe that current drafting already provides for that in the Bill.
As set out in the clause, those meetings are to review any needs of the patient for social care or medical treatment and can make recommendations about whether and how those needs can be met. This should include recommendations about the patient’s communication needs, which may be important in ensuring that their treatment is effective and to support their discharge from hospital. As set out in the clause, a number of named persons and bodies are to have regard to the recommendations of the review. That will give them the appropriate legal weight to ensure that they are considered and that there must be clear reasons if they are not taken forward.
The Bill also introduces statutory care and treatment plans for all patients detained under the Act, excluding those under short-term sections. We plan to set out the required contents of the statutory care and treatment plan in regulations. It is our intention that this includes information about communication needs to enable the treating clinician to consider the protected characteristics and individual needs of the patient, which speaks to the point I made in the first group to my noble friend Lady Whitaker, and to make reasonable adjustments. Regulations will also require that the report from a patient’s care (education) and treatment review is attached to the care and treatment plan so that recommendations are included as part of this.
Finally, I turn to Amendments 19 and 20, tabled and supported by the noble Lord, Lord Scriven, and the noble Baronesses, Lady Hollins and Lady Bennett. These amendments seek to ensure that there is a duty on integrated care boards and local authorities to carry out recommendations from a patient’s CTR, or CETR if the patient is a child or young person, unless there is a compelling reason provided for why a recommendation cannot be carried out. I thank the noble Baroness, Lady Watkins, and the noble Lord, Lord Stevens, for their differing but nevertheless significant contributions.
These review recommendations should be given the appropriate legal weight to ensure that they are given serious consideration. We have decided to include these provisions in the Bill to put the existing NHS England policy on a statutory footing.
The duty to “have regard” is a well-established duty that clinicians, ICBs and other public bodies are used to applying and it already exists within the Act. The noble Earl, Lord Effingham, asked how the Government will ensure that these recommendations are implemented effectively. I hope that my comments will assist the noble Earl. Where effective care and treatment is the central aim, we would expect careful consideration of all recommendations. Where those bodies decide not to accept a relevant recommendation, we would expect them to have very good reasons for making that decision. It is an appropriate duty in this context because we do not intend to place an absolute duty on a body to follow recommendations in every case—that would be incompatible with understanding the individual needs and requirements of the person concerned.
The legislation must not impose unreasonable duties on relevant bodies that they cannot fulfil or where it would be inappropriate for them to do so; for example, if a recommendation was made that was outside of their purview. The Bill already requires that certain named persons or bodies carefully consider the recommendations and give them appropriate weight.
In view of all those comments, I thank noble Lords and ask that they do not press their amendments.
Baroness Barker (LD)
My Lords, I thank everybody who has taken part in the debate on this group of amendments. We were, in essence, trying to get answers to the following questions. Who is responsible for drawing up the care plans and for reviewing the care (education) and treatment reviews? Who is responsible for ensuring that what is in those plans is compliant with the law? Who is responsible for making sure that it actually happens? Who is responsible for finding out whether it has not happened? Who carries the can if it has not happened?
At various points in the Minister’s answer, I was quite hopeful, then, towards the end, we went down the slope quite badly, because it turns out that, apparently, duties will not be put on people, and that is highly regrettable. The Minister does not need to explain to the Committee the difference between a statutory code of practice and a statutory instrument; the issue my noble friend was trying to get to is the extent to which Members of this House will see that these plans reflect what was intended in the law and what scope they will have to call it out if they do not.
I am pleased that it will be a statutory code of practice. That is one step up from nothing—it is not great, but it is better. I am also glad that the Minister said that care and treatment plans will be put in regulations. Will those regulations be done under the affirmative or the negative procedure? That is quite important. In light of all our discussions, we in this House should have the chance to examine that at considerable length and, if it is not right, to have a second go at it.
It is always salutary to sit and listen to the noble and learned Baroness, Lady Butler-Sloss, on the subject on which she is quite rightly famous, not just in the House but outside it. I listened to her strong statement. She will know from other discussions that we have had on the wider subject of health that I have said many times, and I believe it to be true, that we have a health and social care system that is openly predicated on people’s families doing much of the work, and that is never more so than when it comes to discharge. She will have heard me bang on about this before, but I have a considerable degree of concern about what happens to people who do not have families or children. We have never done research on hospital discharge, but I suspect that, if people do not have a relative standing by the bed saying, “No. You are not discharging this person because they are not fit to go home”, they end up being discharged far too early, and I suspect they then go back into hospital as acute admissions a result of that.
That said, I understand what the noble and learned Baroness says about the involvement of parents. However, in 10% of cases, the parent is not the right person. We have heard that in evidence before, which she may recall, where young people who have been subject to mental health treatment have talked about problems within their families. Similarly, people under the Mental Capacity Act have sometimes been the subject of overbearing, overprotective parenting that they have found to be detrimental to them. I am not being anti-parent or asking that parents be excluded. Nobody knows better than the noble and learned Baroness that families are complex, and, as the Minister said, we must make sure that there is the scope to do the right thing for a child.
Baroness Butler-Sloss (CB)
The noble Baroness, Lady Barker, is absolutely right. Any amendment I might put forward in future would have to allow for that, as there must be some parents who would not be suitable.
Baroness Barker (LD)
It is getting late, and people wish to have their dinner because they been here a long time. I think we have had a partial response from the Minister. I believe that care and treatment plans and reviewing them are sufficiently important that some of us will want to go away to see whether, on issues that we may not have got technically right, we can come back, perhaps in discussion with the Minister, to satisfy ourselves.
Baroness Merron (Lab)
When I review all of the debates, particularly where there are areas where we need further discussion or information, I will be glad to pursue that. I give that assurance to the Committee.
Baroness Barker (LD)
I thank the Minister and welcome that. I beg leave to withdraw the amendment.
UK-China Economic and Financial Dialogue
(1 day, 11 hours ago)
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The Financial Secretary to the Treasury (Lord Livermore) (Lab)
My Lords, with the leave of the House, I will repeat the Statement given in the other place by my right honourable friend the Chancellor of the Exchequer. The Statement is as follows:
“Growth is the No. 1 mission of this Labour Government. To grow the economy, we need to help Great British businesses export around the world, including to China. As the second biggest economy in the world and our fourth-largest trading partner, not engaging is simply not an option. That is why I led a delegation, including the Governor of the Bank of England, the chief executive of the Financial Conduct Authority and representatives of some of Britain’s largest financial services firms, including HSBC, Standard Chartered and Schroders, at the 2025 UK-China economic and financial dialogue—the first of its kind since 2019.
This dialogue has delivered a set of tangible benefits to ensure that British firms have greater access to the Chinese market, while safeguarding our national security—the first duty of any Government. In China, I met outstanding British companies, such as Brompton, Jaguar Land Rover and AstraZeneca, that will benefit from the steps that we have agreed. We have worked to lift market access barriers across a range of goods and services, particularly in the agri-food sector. On financial services, we have successfully secured new licences and quota allocations for UK firms to improve operating access in China. We agreed to co-operate further, including by renewing our shared commitment to the UK-China Stock Connect scheme, first launched in 2019, deepening our co-operation on wealth management through a UK-China wealth connect scheme and progressing initiatives on pensions and sustainable finance, delivering significant benefits for UK firms and the City of London. I am pleased that China agreed to issue its first ever overseas sovereign green bond in London during 2025, underlining the UK’s position as a global capital for high-quality sustainable finance.
The UK is a global leader in financial services. There are significant opportunities to expand our presence in new markets. The tangible outcomes that we have delivered this week will help to deliver that. These steps are part of a wider programme to make substantive progress in improving arrangements for UK exporters and investors. This is reflected in new agreements on vaccine approvals, fertiliser, whisky labelling, legal services, automotives and accountancy, which set us on course for this dialogue to unlock £1 billion of value for the UK economy.
These outcomes, agreed with my counterpart Vice-Premier He Lifeng, represent pragmatic co-operation in action and support secure and resilient growth, because security and growth go hand in hand. This means finding the right way to build a stable and balanced relationship with China in our national interest—one that recognises the importance of co-operation in addressing the global issues that we face, competing where our interests differ, and challenging robustly where that is required. In Beijing and Shanghai, I was clear that while we must co-operate on areas of mutual interest, we will confidently challenge on areas where we disagree. I expressed our country’s real economic and trade concerns to the Chinese, including trade imbalances and economic security, and I raised concerns about Russia’s illegal war in Ukraine, human rights, and the restrictions on rights and freedoms in Hong Kong, including the case of Jimmy Lai and the completely unjustified sanctions against British parliamentarians.
A key outcome of this dialogue is that we have secured China’s commitment to improve existing channels, so that we can openly discuss sensitive issues and the ways in which they impact our economy, because if we do not engage with China, we cannot raise our real concerns. This dialogue is just one part of our engagement with trading partners right across the world. Since becoming Chancellor, I have travelled to New York, Washington, Toronto and Brussels to build our global economic relationships, while my right honourable friend the Business Secretary has travelled to the Gulf to boost trade and investment, and my right honourable friend the Foreign Secretary is engaging with partners all over the world to deliver growth that benefits people across the United Kingdom.
We must continue to go further and faster in driving economic growth to make working people better off. That is why, yesterday, the Prime Minister launched our AI opportunities action plan to throw the full weight of government behind artificial intelligence in the UK, revolutionising our public services and making our economy more productive. It is why next week I will be meeting business leaders, investors and entrepreneurs at the World Economic Forum meeting in Davos to make the case that the UK is one of the best places in the world to invest. In the coming weeks, I will be setting out further details of our plans to kick-start growth in the economy after 14 years of failure from the party opposite”.
Baroness Neville-Rolfe (Con)
My Lords, I thank the Minister for repeating the Statement. Instead of focusing only on the economic difficulties, I thought I would start by welcoming the improvement in the terms of our exports to China, which helps, in a small way, to redress the huge imbalance in trade that we have with China. The Chancellor has announced £600 million-worth of opportunities secured in Beijing. She states that barriers that restrict our exports to China in the agricultural sector—that would be pork and poultry, vaccines and fertilisers—will be lifted in an attempt to boost trade. I recall exporting chickens’ feet to China when I worked in the food industry. Will the Minister explain what exactly the real change is here?
Similarly, on financial services, can the Minister explain the improvements apparently being made? The green bond is welcome—I remember helping to launch other green bonds at the Stock Exchange—but can we have more chapter and verse on the other financial services gains? I mean gains to UK plc as opposed just to China—concrete changes that are not just warm words from bankers and legal firms, who obviously find the market difficult. We need to know more about the tangible benefits that the Minister outlined.
More broadly, of course, we are very concerned about the deterioration in the economic position back here at home in terms of debt, interest, rates of inflation and economic growth. In the Chancellor’s absence, the value of the pound plummeted and government borrowing costs rose to a 27-year high.
Let us consider growth. The Government inherited the fastest-growing economy in the G7, yet growth is now non-existent, and that means less money for public services. The Government are rightly exploring some obvious opportunities for growth: planning reform, the use of AI and improvement in skills. However, the fact is that businesses are vital to growth, and they have been dealt a triple whammy of costs.
The recent Budget broke election promises, introduced significant tax hikes and has been detrimental to British businesses and business confidence more broadly. Frankly, confidence is tanking, as many surveys and announcements show. This, combined with an increase in borrowing by an extra £30 billion a year, has inevitably caused international markets to question the future of the UK economy.
Instead of looking forward, there is much talk on the Benches opposite about the mythical black hole, but much of this is of the Government’s own making: over £8 billion on a public energy company, over £7 billion on a National Wealth Fund and nearly £10 billion of taxpayers’ money on public sector pay settlements without—this is so important—any requirement for a productivity return, at the very moment when it is right to extract one.
While many on the Government Benches may point to an international trend of rising borrowing costs, it should be noted that the gap between our bond yields and those of similar economies is growing. We now find ourselves in a position in which the UK’s long-term borrowing costs have risen to the highest level in nearly 30 years, and the pound has been at a 14-month low.
Can the Minister tell the House how the Government intend to address and restore stability in international markets? The increase in our borrowing costs is believed to have added roughly £12 billion to the UK’s annual spending in debt interest; that is 100 times what the Chancellor claims she accrued from her trip to Beijing. This £12 billion could have covered the costs of the winter fuel payment cut for eight and a half years or funded 300,000 nurses. According to the OBR forecast, two-thirds of the money raised from the Government’s jobs tax will have to be used to finance additional debt interest. As a consequence of the Chancellor’s policies, borrowing by the final year of the forecast will be doubled.
I repeat the question I posed to the Minister earlier today and encourage him to be more forthcoming. Will the Government do a U-turn on the spending increases that the Chancellor promised in the Budget? Will they borrow more or will they increase taxes further? One of these will have to give if the OBR’s update in March determines that the Chancellor is in breach of her own fiscal rules.
I am afraid that it is working people who will pay the price of the unfortunate decisions made by this Government in their Budget.
Baroness Kramer (LD)
My Lords, we must not allow anxiety about America under Trump and Musk, particularly on tariffs and climate change, to drive us into an unhealthy economic relationship with China. China is, of course, an economic powerhouse and our fourth-biggest trading partner, and there is more trade to be had, especially in financial services, to benefit both parties—but China is a very mixed blessing. It remains a cyber threat. Without greater transparency and safeguards, it is a potential threat to the integrity of our national security. It does not challenge the Russian invasion of Ukraine. It does not share our commitment to human rights and to democracy in Taiwan and Hong Kong. The imprisonment of Jimmy Lai is both a tragedy and a warning that our values are not respected. We on these Benches wish that the Chancellor had held firm and refused to go to China unless Jimmy Lai is released. China is a country that exploits weakness.
In light of these concerns, will the Government strengthen foreign direct investment screening and cyber defences, including increased data transparency requirements? Will they cease research co-operation on technology with China, its companies and researchers if adequate reciprocity and transparency cannot be achieved? Will they enact Magnitsky legislation to hold Hong Kong and Chinese officials responsible following gross breaches of human rights in Hong Kong and Xinjiang province? Given the recent discovery of Chinese spying across several senior levels of the British establishment, do the Government agree that China should be placed in the enhanced tier for the foreign influence registration scheme?
Lord Livermore (Lab)
My Lords, I am grateful to the noble Baronesses, Lady Neville-Rolfe and Lady Kramer, for their questions and contributions. I am grateful to the noble Baroness, Lady Neville-Rolfe, for her initial welcome for the improvements in the trading relationship and the consequences they will have. As both noble Baronesses will know, delivering economic growth is this Government’s number one mission. It is central to raising living standards, creating wealth and opportunity, and delivering well-funded public services.
While the OECD forecasts that our economy will grow faster than those of Germany, Italy, France and Japan over the next three years, the latest growth figures show the scale of the challenge we face. The Government are therefore determined to go further and faster in driving economic growth and making working people better off, including by supporting British businesses to export around the world.
I do not think that the noble Baroness, Lady Kramer, was suggesting this but, in this context, it is clearly not an option simply to ignore China, the second-biggest economy in the world and our fourth-largest trading partner. The Government will work with China on trade, investment and climate change while safeguarding our values and security. While our G7 partners invested heavily in dialogue with China in recent years, the UK fell behind due to the inconsistency in approach of the previous Government.
In addition to hampering our ability to deliver growth for the UK, this approach of disengagement also risked leaving the UK out of critical conversations on issues vital to the UK’s national security. In contrast, the UK-China economic and financial dialogue represents a decisive first step to restarting substantive engagement on important economic issues.
The noble Baroness, Lady Neville-Rolfe, asked specifically about financial services outcomes. The Government have successfully secured new licences and quota allocations for UK firms to improve operating access in China. We have progressed initiatives on pensions and sustainable finance, delivering significant benefits for UK firms and the City of London. Additionally, China has agreed to issue its first overseas sovereign green bond in London during 2025, underlining the UK’s position as a global capital for high-quality, sustainable finance.
Importantly, the UK and China also signed new agreements on vaccine approvals, fertiliser, whisky labelling, legal services, automotives and accountancy, which sets us on course for this dialogue to unlock £1 billion of value for the UK economy. The noble Baroness, Lady Neville-Rolfe, slightly questioned the value of the £600 million that has been secured, but £600 million is a lot of money and delivers significant benefits for the UK, with new agreements in several important areas.
Of course, we accept that there is still more progress to be made; we must keep the momentum going forward, particularly in green finance. The Government would also like to see the UK and China further enhancing co-operation on capital market connectivity, wealth management and pensions.
The noble Baroness, Lady Kramer, spoke extensively about security and the role of human rights, and obviously security and growth go hand in hand. That means finding the right way to build a stable and balanced relationship with China that is in our national interest—one that recognises the importance of co-operation and addressing the global issues we face, competing where interests differ and challenging robustly whenever that is required. That is why, on her visit, the Chancellor expressed the UK’s real economic and trade concerns to the Chinese, including trade imbalances and economic security. She also raised Russia’s illegal war in Ukraine, human rights and the restrictions on rights and freedoms in Hong Kong, as the noble Baroness quite rightly raised, including the case of Jimmy Lai, and the completely unjustified sanctions against British parliamentarians. Importantly, the UK also secured China’s commitment to improve existing channels so that we can openly discuss these sensitive issues and the ways in which they impact our economy. If we do not engage with China, we cannot raise these very real concerns.
The noble Baroness, Lady Kramer, raised a number of security concerns and asked about security risks. National security is at the heart of everything the Government do. Our engagement with China is pragmatic and necessary to support the UK on global interests. We must speak often and candidly across areas of contention as well as areas where co-operation is in the UK’s national interest. We firmly recognise that the UK and China will not and do not always agree. The Chancellor’s visit was a platform for respectful and consistent future relations with China, one where we can be frank and open on areas where we disagree, protect our values and security interests and find opportunities for safe trade and investment.
The noble Baroness also asked about putting China on the enhanced security tier. I am not going to get ahead of any announcements and speculate which countries might be specified on the enhanced tier at this stage, nor would I comment on matters of national security, but, as I have said, work is under way to identify which foreign powers will be placed on the enhanced tier. That will be based on a robust security and intelligence analysis.
The noble Baroness also asked whether the Chancellor challenged her Chinese counterparts on human rights. I can confirm that yes, of course, the Chancellor raised human rights. In all our engagements with the Chinese Government, we continue to challenge them robustly on human rights violations and continue to raise our concerns at the highest levels of the Chinese Government.
The noble Baroness, Lady Neville-Rolfe, asked about growth. The Government intend to build a platform for a stable long-term economic relationship with China that works squarely in our national interest. That is essential to our growth strategy. But, of course, our engagement with China is just one part of the action we are taking to drive growth. Internationally, we are engaging with key partners around the world, and that is why the Chancellor has travelled to New York, Washington, Toronto and Brussels to build global economic relationships since taking office. Domestically, only yesterday the Prime Minister launched an AI Opportunities Action Plan. Next week, the Chancellor will be meeting business, investors and entrepreneurs at the World Economic Forum in Davos, and in the coming weeks she will be setting out further details of our plans to kick-start growth in the economy.
I was surprised that the noble Baroness, Lady Neville-Rolfe, raised my favourite issue of the £22 billion black hole. I am happy to say that she is mistaken in her analysis of the composition of that black hole. She knows full well exactly the number the previous Government left behind. She is also mistaken in saying that we have made no productivity requirements in the Budget. We set out a 2% productivity requirement for every department, unlike the previous Government who had done no such thing.
The noble Baroness also asked about the fiscal rules. It is absolutely clear that we will meet the fiscal rules. They are non-negotiable. It is interesting that the noble Baroness repeated the party opposite’s opposition to every one of the tough and difficult decisions we have taken to repair the public finances and repair that £22 billion black hole in the public finances. I notice she did not speak out against what we are spending that money on but did against raising that money, which is exactly why we ended up with a £22 billion black hole in the first place. She asked about the action we will take. She should have no doubt that we will take the tough action necessary to ensure that we meet our fiscal rules.
In conclusion, establishing a stable and balanced relationship with China—our fourth-largest trading partnership—is clearly in the UK’s national interest. The Government will, of course, continue to take a consistent approach, co-operating to address the global issues we face, competing where our interests differ and challenging robustly whenever that is required. The Chancellor’s visit last week shows how pragmatic collaboration can deliver tangible outcomes that support secure and resilient growth. That is why the Government will go further and faster to drive economic growth to make working people better off, including by supporting British businesses to export around the world.
Lord St John of Bletso (CB)
My Lords, in welcoming this Statement, can I ask the Minister to elaborate on what bilateral agreements are being discussed on the governance of AI, which is becoming such a critical development globally?
Lord Livermore (Lab)
It is a very good question; I am sorry that it is the first question that I do not have an answer to. I will write to the noble Lord on that point.
The Earl of Effingham (Con)
My Lords, I declare an interest as stated on the register. Following on from the question from my noble friend Lady Neville-Rolfe, UK inflation was 1.7% in September, it was 2.3% in October and it was 2.6% in November, so inflation is going up. UK real GDP growth was revised down to show no growth from July to September. Sterling is falling more than other currencies. That is all UK specific. Please can the Minister give us a rough date by which he will deliver a positive UK growth number?
Lord Livermore (Lab)
I commend the noble Earl for his efforts to try to portray the previous Government’s record on the economy as some kind of success, whereas everyone listening both in the Chamber and outside knows that it was 14 years of total catastrophe. He mentioned inflation as if 33 months in a row above the Government’s target was something to be proud of, when we know that it hurt family finances dramatically over that time. He tried to say that the previous Government did well on growth, when we know that growth was one of their biggest failures. They took investment out of the economy at a vital moment with their austerity programme. They reduced GDP by 4% as a result of their Brexit deal, and then the Liz Truss mini-Budget crashed the economy, sending mortgage rates soaring by £300 a month, for which ordinary working people are still paying the price. I really reject the fundamental basis of the noble Earl’s question. He asked about timing. He knows very well that it is very difficult to turn around 14 years of failure. We cannot do that in six months, but we are determined to do it and will do whatever it takes to turn around the British economy.
Baroness Neville-Rolfe (Con)
I am not sure I am supposed to speak, but I would just say that there was also something called Covid and an energy crisis and Ukraine. It would be good if the Minister sometimes mentioned those as well as some of the other factors.
Lord Livermore (Lab)
I know the noble Baroness is desperate to find any scapegoat or excuse for her party’s total failure on the economy. Of course, there are international factors at play, but perhaps she could tell us why the UK was worse affected than any other country in the G7 and any other European country as a result of those things. It is because their austerity and their Brexit left this country more exposed and we therefore suffered far worse than any other country.
Lord Grantchester (Lab)
My Lords, this was an important visit. I welcome the Statement and endorse the importance of productive trade deals around the world leading to growth opportunities. I am pleased that the agritrade restrictions have been lifted. The UK has enjoyed a beneficial relationship with Taiwan, especially with regard to its world-leading semiconductor industry. In the visit to China over the weekend, was the position of Taiwan part of the conversations? Can the Minister assure the House regarding continuing trade relationships with Taiwan, against the background of the newly signed CPTPP deal and the pressures across the strait from Chinese challenges?
Lord Livermore (Lab)
I am grateful to my noble friend for raising those important trade issues. I can assure him that, having just acceded to the CPTPP trading relationship, we are absolutely committed to continuing that relationship and to building trade relationships in that manner. On Taiwan specifically, we consider the Taiwan issue one that should be settled peacefully by people on both sides of the Taiwan Strait through dialogue, not through any unilateral attempts to change the status quo.
Baroness Bennett of Manor Castle (GP)
My Lords, in responding to the noble Baroness, Lady Neville-Rolfe, just now, the Minister said that their austerity—referring to the Tory Government’s austerity—has left us worse off. Can the Minister assure me that we will not see further damaging austerity of the kind that has already left us with a terrible level of public health, teetering Civil Service departments that cannot keep up with their responsibilities and local government in crisis? Can he say that we are not going to see more of that from this Government?
Lord Livermore (Lab)
I am grateful to the noble Baroness for her question. I cannot remember what the Green Party’s position is on the national insurance increases that we have put in place. I certainly hope that she is not opposing those increases but supporting the extra investment that we are putting into the National Health Service as a result, because that would not be terribly coherent. We are committed to investing in our public services. The Budget we just had, in October, announced £100 billion more of capital investment. I certainly would not describe that as austerity.
Baroness Bennett of Manor Castle (GP)
Since the Minister came directly at me, I very much invite him to look at the Green Party manifesto from the recent election. It remains our position to raise money from a range of sources to put vastly more investment into the NHS and many other government programmes, particularly through a wealth tax. I invite the Minister to look at it.
Since I am on my feet, the question that I was originally going to ask relates to the position of Jimmy Lai, as raised by the noble Baroness, Lady Kramer. Does the Minister agree that the situation of British citizen Jimmy Lai reflects the fact that there is no rule of law in China? In encouraging British businesses to further invest and become involved in China, is there not a significant risk to both their capital and staff where there is no rule of law? I am concerned that the Statement speaks with praise of HSBC and Standard Chartered. I do not know whether the Minister is aware of the situation where those companies have refused to hand over to Hong Kongers—BNO passport-holders who have come to the UK—their own money in pension funds.
Lord Livermore (Lab)
I am grateful to the noble Baroness for her follow-up question. I am sure that the Green Party manifesto is a cracking read and I will endeavour to read it, if I have time. I note that she did not say that she was in favour of the national insurance increase, so I take it that she is supporting the investment without supporting the means to raise that investment.
The noble Baroness asked specifically about British national Jimmy Lai. His case is a priority for the UK Government. The Chancellor raised this Government’s concerns about the case during her visit to China. The UK has called for the national security law to be repealed and for an end to the prosecution of all individuals charged under it, including Jimmy Lai. We continue to call on the Hong Kong authorities to end their politically motivated prosecution and immediately release Jimmy Lai.
Mental Health Bill [HL]
(1 day, 11 hours ago)
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Lord Cryer
Member’s explanatory statement
This amendment and my other amendments to Clauses 4 and 43 are minor and technical amendments to clarify that the references to after-care services include services arranged (as well as directly provided) by a public authority under section 117 of the Mental Health Act 1983.
Lord in Waiting/Government Whip (Lord Cryer) (Lab)
My Lords, in moving government Amendment 7, in the name of my noble friend the Minister, I shall also speak to government Amendments 14, 87 to 94, 127, 161 and 162, also in the name of my noble friend the Minister.
The minor and technical government Amendments 7, 14 and 127 make changes to Clauses 4 and 43 to clarify that the references to aftercare services include services arranged, as well as directly provided, by a public authority under Section 117 of the Mental Health Act 1983.
I turn to government Amendments 87 to 94, which concern Clause 31, and Amendment 162 on the commencement of certain provisions within Clauses 29, 31 and 34. Amendments 87 to 94 divide Clause 31 into two clauses to allow for automatic referral rights to the mental health tribunal to be commenced separately for patients who will be subject to conditional discharge subject to deprivation of liberty conditions. This is an important safeguard for this new form of conditional discharge, given the level of restriction that these individuals will be under. Under Clause 31, patients conditionally discharged under deprivation of liberty conditions will be referred to the tribunal 12 months post discharge and every two years thereafter.
Amendment 162 amends Clause 53 to adjust commencement for certain provisions currently commenced by regulations to be commenced two months after Royal Assent, and vice versa. Automatic referral to the tribunal under Clause 31 and increased application rights under Clause 29(2) shall now commence at two months post Royal Assent for conditionally discharged patients subject to deprivation of liberty conditions. That is to coincide with the introduction of this new subset of conditional discharge at Clause 33 and ensures that the new measure is introduced with the full suite of carefully considered safeguards in place.
Amendment 162 also adjusts commencement for the change of detention criteria for transfers from places of detention to hospital under Sections 47 and 48 of the Mental Health Act 1983 to commence via regulations. This change in the detention threshold ensures that the detention criteria can be met without the need for a hospital bed to be identified, and is closely linked to the introduction of the statutory time limit at Clause 35. The ability to commence this reform simultaneously with the time limit at Clause 35 will allow for streamlined implementation planning around the new statutory notice process and accompanying guidance.
Finally, government Amendment 161 creates an equivalent power for Welsh Ministers to make consequential provision in areas of their devolved legislative competence. This is a limited power and allows Ministers to make regulations containing such provision as they consider necessary to deal with legislative consequences that arise as a result of the Bill. The power cannot be used to make substantive policy changes. This new clause would mirror the powers of the Secretary of State, as set out in Clause 51. This provision was requested by the Welsh Government in their legislative consent memorandum, in which they recommended that the Senedd grants consent to the Mental Health Bill. We believe that this is appropriate, and I am grateful to the Welsh Government for their close collaboration and support for this important piece of legislation.
I hope that noble Lords are able to support these technical and necessary amendments. I beg to move.
Lord Kamall (Con)
My Lords, I am sure the noble Lord is thinking, “If only all groups went as swiftly as this one”. I thank him for bringing forward these government amendments. We understand that although they are largely technical in nature, they address some important points regarding the delivery of aftercare services, tribunal reviews and the broader application of this legislation.
We see the point of Amendments 7, 14, and 127 to clarify the references to aftercare services under Section 117 of the Mental Health Act, including services arranged by public authorities in addition to those directly provided. We understand that this reflects the practical realities of service delivery and may help to avoid ambiguity in how these obligations are interpreted. If we have heard any lesson throughout this debate, it is about how we avoid ambiguity when it comes to the treatment of patients.
We understand also that Amendments 87 to 94 focus on tribunal reviews for patients subject to conditions amounting to a deprivation of liberty, which we have discussed in other groups. The proposal to commence these provisions two months after Royal Assent is pragmatic and necessary to provide patients with timely access to justice. The amendments also introduce a new clause requiring the Secretary of State to refer certain cases to the tribunal within defined timelines. We agree that this will ensure that patients who are conditionally discharged but not recalled to the hospital are not left in a state of indefinite uncertainty. Once again, that was covered in the last group of amendments as somewhere where the patient could fall between the cracks, as it were. Timely tribunal reviews are essential for safeguarding patients’ rights and ensuring that any conditions imposed remain proportionate and necessary.
We understand also that Amendments 161 and 162 propose adjustments to the commencement of specific provisions, including granting Welsh Ministers powers to make consequential provisions within their devolved competence. Though these amendments are largely procedural, they underline the importance of clarity in implementing the reforms set out in the Bill. Of course, we understand that healthcare is a devolved matter. I remember having to deal with the devolved Administrations when I was a Health Minister, and we always did so collaboratively. Welsh Ministers should indeed have the same right to make consequential provisions, although if I have a question for the Minister, it is: what safeguards and oversight mechanisms will be in place to ensure equal application of the Bill to Wales, as in England? I am sure he will be aware that we have sometimes had questions in this place as to why the standard of health or social care in another part of the United Kingdom might be different, even understanding that it is due to devolution. Are there any safeguards to ensure that one part of the UK is not seen as having an inferior service to the rest of the UK? How would the Government address that?
With that, we very clearly understand that these are technical amendments and we will not oppose them.
Lord Cryer (Lab)
I am grateful to the noble Lord and take his point about ensuring there are equal standards across the devolved Parliaments and Assemblies. However, nothing is guaranteed. As he undoubtedly did when in government, we will endeavour to collaborate with Welsh colleagues—as well as others—to ensure that equal standards are applied across England and Wales. That includes regular contact with the Senedd and the Welsh Executive on a variety of matters, including health. That may be a slightly vague answer, but at the moment it is the best I can do.
I thank the noble Lord for his other comments. I have spoken about the need for these minor, technical and necessary amendments, and I hope noble Lords can support them.
Lord Kamall (Con)
This raises another issue, which I know has been raised in other areas of healthcare, of families who live across borders—if the parents live in one part of the United Kingdom and the children live in another, or if someone who has lived away from home moves back. I do not expect an answer now, as that would be unfair, but if the noble Lord could write to noble Lords on cross-border issues, where someone has commenced care in one area but then they or their parents have moved to another area, that would be satisfactory. We had a number of issues around this in healthcare, particularly mental health care, and it is important to resolve them.
Lord Cryer (Lab)
I am happy to do that. I remember having those sorts of issues when I was a Member of the other place. Probably a number of us have experienced them. I suppose that, at present, it is how it has always been: you have to try to communicate with the respective authorities and bring them together so that there is some sort of continuity.
Lord Cryer
“(The arrangements may also include provision authorising or requiring a copy of the report to be given to other persons.)”Member’s explanatory statement
New section 125A(3)(b) requires arrangements to include provision for reports to be given to the people listed in that provision. This amendment provides, for the avoidance of doubt, that arrangements may also include provision for reports to be given to others.
Lord Cryer
Member’s explanatory statement
See the explanatory statement for my amendment to Clause 4, page 5, line 20.
Lord Cryer
“(The arrangements may also include provision authorising or requiring a copy of the report to be given to other persons.)”Member’s explanatory statement
New section 125B(3)(b) requires arrangements to include provision for reports to be given to the people listed in that provision. This amendment provides, for the avoidance of doubt, that arrangements may also include provision for reports to be given to others.
Baroness Tyler of Enfield
“(ba) the person is under 18 years old and satisfies the conditions in (b)(i) and (b)(ii),”Member’s explanatory statement
The amendment inserts a new subsection that extends the duty on integrated care boards to establish and maintain a register for those at risk of detention to all children and young people under the age of 18.
Baroness Tyler of Enfield (LD)
My Lords, I will also speak to Amendments 27 and 32 in my name. My amendments all relate to children and young people, but this group also includes important amendments in the name of my noble friend Lord Scriven, which I support, on the duties on commissioners, integrated care boards and local authorities regarding care provisions for people with a learning disability or autism. Also important are the amendments from the noble Baronesses, Lady Browning and Lady Hollins. I add my condolences to the noble Baroness, Lady Hollins. I am sure we are all thinking of her today.
By way of context, the Bill introduces a new duty on integrated care boards and local authorities to commission community services for those with a learning disability and autism. The Bill also places dynamic support registers on a statutory footing. These are welcome and much-needed duties, and the Bill presents a crucial opportunity to strengthen the support provided to those with learning disabilities and autism. However, I want to go further. I recognise that there is some piggybacking on my part, but I am passionate about the mental health support that is available to children and young people, so I believe that the duties to provide community services should be extended to include everyone aged under 18, to ensure that children and young people can have their needs met without them having to be admitted as in-patients. That is where is my Amendments 21, 27 and 32 come in—they are all interrelated.
Amendment 21 seeks to extend the duties placed on integrated care boards to maintain a register of those at risk of detention to all under-18s. Amendments 27 and 32 would extend the new commissioning duties on integrated care boards and local authorities to include under-18s. In essence, the duties are both to identify and to commission services in the community that meet the needs of all under-18s.
As I think we all know, the Bill has been introduced at a point when waiting times and thresholds for mental health support for children and young people across early intervention services, targeted support services, CAMHS, et cetera are worryingly high. Consequently, too many children and young people are left to reach crisis point. Evidence shows that the number of children referred to emergency mental health care in England has increased by more than 50% in three years. These amendments will not only help to achieve improved outcomes for children and young people but have wider benefits for the mental health systems through intervening at an earlier stage, providing improved care for children and young people in the most appropriate settings, and reducing costs. This is all in line with the Government’s key drive to move to a more community-based, preventive model of healthcare—and, frankly, that should apply to mental health as well as to physical health, and to children and young people as well as to adults.
We all know, as we have discussed so many times in this Chamber, that children’s mental health support has historically been woefully underfunded. There is a lack of clear accountability to ensure that effective community provision is in place. I therefore consider that adding all children and young people to the new commissioning duty placed on local authorities and ICBs in the Bill is crucial to ensuring that their needs can be met at an early stage, preventing crisis and later admission to mental health in-patient care. We should worry about the whole system and try to prevent people getting to in-patient care, as well as worrying about those who do. In short, my argument is that their needs should be met without the need to detain children and young people, wherever that is possible.
Research has demonstrated that children’s and young people’s experience of in-patient care is consistently poor, too often further harming their mental health. A survey conducted by Mind on children’s and young people’s experience of care in mental health hospitals found that 69% of the young people surveyed said that their experience as in-patients had not been positive. In my view, a shift to such community-based provision would not only reduce the number of children and young people requiring in-patient beds but would in turn reduce demand for in-patient care and the risks of children and young people being cared for in what can often be highly unsuitable environments. It would also ensure that those with the most complex needs who do need in-patient care receive high-quality care in a setting that is right for them.
In case people are sceptical as to whether this sort of care can be provided in the community, I am aware of case studies of types of support in the community, such as hubs and the like, that can be used to manage high levels of risk. Where that care is provided in the community, in a relaxed, warm and calm environment, it can often be an alternative to young people having to visit A&E, where they may not get specialist mental health support and waiting times can be so long. I beg to move.
Baroness Browning (Con)
My Lords, this group includes Amendment 22, tabled by the noble Lord, Lord Scriven, to which I have added my name—to which I will not speak because I think it will be fully discussed—and two amendments in the name of the noble Baroness, Lady Hollins. She is a dear colleague and friend of many years, and this is my first opportunity in the debate to express my personal sympathy for her loss this week.
I will speak to Amendment 28 in this group, which is in my name. In addition to local authorities’ market-shaping function—I have to say I find the choice of words there a little difficult; I had to read it a few times just to make quite clear that I know what that is—the Bill includes reference to the “commissioning functions” of local authorities when having regard to information from risk registers and ensuring that the needs of people with a learning disability and autistic people are met.
Under the Bill, new Section 125G makes it clear that integrated care boards’ commissioning functions are related only to health services. New Section 125E(3) makes clear that
“‘market function’, in relation to a local authority, means its function”
to
“promoting diversity and quality in provision of services”
under the Care Act 2014. This amendment would add local authority commissioning explicitly, by which is meant the local authority’s commissioning duties in relation to providing care and support under the Care Act 2014. The proposed duty in relation to local authority market shaping does not adequately cover local authority commissioning. The issue of poor commissioning in relation to this group has been frequently cited in reports. This is an opportunity to redress that and to be clear about their function.
Lord Scriven (LD)
My Lords, I will speak to Amendments 22, 24, 25, 26, 29, 30 and 31 in my name in this group. I support Amendment 28, which was just spoken to very ably by the noble Baroness, Lady Browning, and Amendments 36 and 37, in the name of the noble Baroness, Lady Hollins. I want to put on record my condolences to her at what must be a very sad and difficult time.
Quite a number of amendments that I have put down in this group, particularly Amendment 22, are about prevention. It is about getting upstream and trying to use the dynamic support registers—the risk registers—in a better way, and, by so doing, having the correct information that is available to a place, rather than just to an organisation, such as the NHS or the ICB, within that place.
Amendment 22 would ensure that local authorities have an active role in assisting ICBs in identifying people for inclusion in the risk registers. NHS England’s policy and guidance on dynamic support registers states:
“Early identification of people at risk of admission to a mental health hospital and their access to person-centred planning and support are essential for the prevention of avoidable admissions”.
Many people with risk factors will first come into contact with a local authority, particularly people with learning disabilities and autism. It is important that the local authority has a clear responsibility to assist ICBs in identifying people for inclusion on the register, to ensure that people get the right support at the right time. I hope that the Minister will take this amendment in the spirit that it is given. This is an important issue which is not strong enough in the Bill and which really needs to be taken account of.
There have been difficulties for some people getting enrolled on the DSR, and this is particularly true for autistic people without a learning disability. Additionally, NHS England data shows that 52% of autistic people and people with a learning disability detained in a mental health hospital are not on a risk register prior to admission. Therefore, there is a gap, and the Bill gives us a chance to help plug it. Hopefully, placing this duty on local authorities will facilitate greater uptake and enrolment on the register for all, therefore helping to reduce admissions, improving support in the community and being a good preventive measure.
Coupled with this, Amendments 36 and 37 in the name of the noble Baroness, Lady Hollins, would help with that prevention role by making sure that proper provision was available. Taken together, Amendments 22, 36 and 37 would be a really good group of steps forward to help with preventive measures to make sure that all people who can be identified who come into contact with a local authority but are not known to the ICB go on the register, and that provision is made.
Amendments 24 and 29 would change the current language in the Bill. After listening to debate on previous amendments, I will not labour the point because I have a good idea what the Minister might say, but again I think the provision needs to be strengthened so that ICBs and local authorities have a duty to consider the risk register when exercising commissioning and marketing functions.
In Amendments 25 and 30 there is the same approach by strengthening the words in the Bill to ensure that ICBs and local authorities have a duty to ensure that the needs of autistic people and people with a learning disability are met in the community wherever possible. The current language in the Bill states only that ICBs and local authorities must “seek to ensure” that the needs of autistic people and people with a learning disability are met. This wording is vague and does not compel a strong enough duty to meet the needs of people in the community. Again, the amendments in the name of the noble Baroness, Lady Hollins, would strengthen my amendments even further.
These amendments are important. I hope that the Minister has listened very carefully, will make efforts to implement some of these steps and reports back on Report.
Lord Crisp (CB)
My Lords, I will speak to my noble friend Lady Hollins’s Amendments 36 and 37. I add myself to the comments by the noble Baroness, Lady Watkins, about the remarkable commitment that my noble friend is showing at this awful time and express my personal condolences. What I am going to say is based on comments that she has passed to me. I should perhaps say at the beginning that I too am an honorary fellow of the Royal College of Psychiatrists—“(unqualified)”, as others have made that disclaimer.
The purpose of these amendments is very clear. Amendment 36 states that ICBs
“must ensure the availability of integrated comprehensive, accessible, and responsive community services for autistic people and people with learning disabilities … to reduce hospital admissions … and … reliance on restrictive interventions”.
As the previous two noble Lords said, it is very much about prevention and creating appropriate services.
I note that the Explanatory Notes to the Bill say that Clause 4
“is designed to help ensure that ICBs can monitor individuals at risk of detention and put in place the necessary preventative measures to help keep people out of hospitals”.
Putting it simply, this amendment takes that rather weak wording in the explanation and toughens it up. The issue here is not about good intentions and ensuring that it is possible for something to happen. I am sure that all noble Lords share the intention and the hope that these things will be in place, but this is about making sure that something happens. It is about implementation and seeing that a change happens.
This is vital because it is clear that there are major problems in service coverage right now. For example, only a quarter of integrated care systems are meeting their target of having only 30 people per million admitted. Of course, that number would ideally be much lower than it is, but only a quarter of these systems are even meeting that. Amendment 36 spells out what these services should include. I will not read them out in detail but noble Lords can see that they cover all the relevant areas that one would expect: evidence-based treatments, crisis prevention and intervention services, non-restrictive walk-in services, and the provision of “suitable housing”.
I will comment on two of those items in a moment. All of them are important but what I think the noble Baroness, Lady Hollins, had in mind was not just discussing these items but seeing her amendment as an opportunity to discuss which services are the right ones—the ones that should be there—and which areas ICBs and local authorities should address. The key point at this stage is not so much about the detail but the need for some clear legislative requirements on what services must be provided. Good intentions are simply not good enough; implementation is what is needed.
I will mention two of those items that relate to points made earlier by other noble Lords in our debates on this group and others. One is the reference to “non-drug-based interventions” and “social prescribing”; their importance in community services applies in all kinds of ways. The second is the point about housing, which, as has been discussed, is vital. Ten years ago, I did a review for the Royal College of Psychiatrists on discharges from acute adult hospitals. A third of the people in those hospitals were there because they did not have adequate accommodation anywhere else. That third included people who had nowhere to be discharged to, in terms of adequate housing. It is a really serious issue. I make those points because both of these issues go beyond this amendment: in some ways, they are not about healthcare as much as they are about enabling people to have a decent life and creating the conditions for people to be healthy and live in the best way possible.
Amendment 37 is about issuing guidance on standards and monitoring and reviewing progress. Again, without that, we cannot be sure that this legislation will make a difference to the people who matter.
I will make three final points. I recognise that there are perverse issues of finance here because, of course, the NHS pays when people are in hospital and the local authority pays for the services in the community. Of course, that reminds us all of the need to get the social care policy right and the importance, wherever the boundaries fall between public bodies, of using public money wisely across organisations.
In that context, I stress that what the noble Baroness, Lady Hollins, has set out in this amendment is not an unachievable wish list. Even in today’s circumstances, some people are making real progress. Mencap pointed me towards the Black Country’s emergency response team, which noble Lords may know about and which meets many of these criteria for services. In 2022-23, it supported 51 people who were presumably being paid for by the local authority and who might otherwise have been admitted for the equivalent cost of a single assessment and treatment bed, presumably paid for by the NHS. Preventive and good-quality services so often make good financial sense, as well as being better for the people concerned. I do not know whether the Minister is familiar with that project but I would certainly encourage her to have a look at it if she has not already done so.
The second point I want to make is that, although I have not actually checked the reference, I believe that the Minister said something at Second Reading about delaying the implementation of some parts of this Bill until the services are in place. I would be grateful if she could say what was meant by that, but also why it is necessary when people can make progress quite quickly.
The Black Country example—and I suspect that there are others—shows that people are making progress and that, in many ways, it is better to have a stretching target that people are moving towards rather than saying, “If you don’t have the services, we won’t implement the legislation”. We need to keep moving forward and show faith both in what this Bill is designed to achieve and in the Government’s agenda on prevention and on moving towards the community. No doubt the digital transformation is also extremely relevant here.
The Earl of Effingham (Con)
My Lords, I thank the noble Baroness, Lady Tyler, my noble friend Lady Browning, the noble Lord, Lord Scriven, and the noble Baroness, Lady Hollins—who sadly is not in her place today—for their amendments in this group.
Given that it is now widely accepted that we should be moving towards a system of health and care focused on prevention, these all appear to be sensible amendments. They seek to understand how integrated care boards and local authorities are identifying those with autism or learning disabilities, the risk of them being detained and, if appropriate, the risk to the community, as well as ensuring that those with autism and learning disabilities receive the appropriate level of care.
Amendment 28, in the name of my noble friend Lady Browning, specifies that local authorities must seek to ensure the needs of people with autism and learning disabilities can be met without detention when they are exercising not only their market function but their commissioning functions. This acknowledges the roles that local authorities play in commissioning health and social care. Local authorities commission publicly funded social and healthcare services, many of which interact with mental health service provision, such as authorised mental health professionals and addiction services. By explicitly mentioning the commissioning functions of local authorities and not just the market functions which arise out of the Care Act 2014, this amendment gives the Bill greater clarity.
The noble Baroness, Lady Hollins, has tabled Amendments 36 and 37 in this group, which relate to the provision of community services for autistic people. These amendments are in a similar vein to Amendment 139 in the name of my noble friend Lord Kamall, which will be discussed in the next group and which seeks to ensure a greater availability of community services. Amendments 36 and 37 expand the duties on integrated care boards and local authorities to provide better and more responsive care to those on dynamic support registers.
Of particular interest is subsection (3)(a) of the new Section 125I proposed in Amendment 37. That new provision states that integrated care boards must
“establish digital systems to … assess, monitor, and address sources of inequality”
arising out of the current provision of mental health care. As my noble friend Lord Kamall has been keen to stress, digitalisation in health and social care is the way forward for improving productivity and ensuring the best possible care outcomes.
I know the Minister believes in the value of the expanded use of technology and digital systems, and it would be welcome if she could give some commitment here. When we hear from her, we would be interested in whether there are any legal reasons for not being able to accept what these amendments seek to do, such as around issues of privacy, or whether the barriers are financial. We very much look forward to the response of the Minister.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, I am most grateful to the noble Lords present for their contributions this evening. Perhaps I can make a general point to the noble Baroness, Lady Tyler, and the noble Earl, Lord Effingham, about the main pillars of change which we look forward to in the 10 year-plan. The noble Earl has just referred to one of them, which is the move from analogue to digital. In that context—the noble Baroness raised a point about parity between mental health and physical health—the moves from sickness to prevention, from hospital to community and from analogue to digital apply at least as much to mental health as they do to physical health. That is our way forward. I am looking forward to the 10 year-plan to really give structure to that.
Let me turn to Amendment 21, tabled by the noble Baroness, Lady Tyler. This amendment seeks to ensure that the register under new Section 125D includes autistic children and children with a learning disability who have risk factors for detention, so that they can be supported in the community. We absolutely agree with the intention behind the amendment, although I have to say that it is regarded as unnecessary because the current drafting does not limit the duty to adults; it includes anyone who meets the other criteria, including children, which I know the noble Baroness is rightly looking for. The register is designed to provide health and care bodies with additional information about the needs of those with a learning disability and autistic people who have risk factors for detention under Part II of the Act. That is to ensure there is a particular focus on their needs, so that they can be better supported in the community.
The noble Baroness, Lady Tyler, made the observation, which I understand, about too many children being left to reach crisis point and the increase in the number of children in need of mental health services, particularly over the last three years. I very much recognise this concern. We have seen an increase in referrals and access across children’s and young people’s mental health services, including crisis services. This is due to an expansion of the services to meet need but also to an increase in prevalence and intensity. It might be helpful if I indicate that NHS England is in the process of developing proposals for a new model of specialised children’s and young persons’ mental health services, supported by a new service specification and quality standards. This new approach would support delivery of specialised services in the community, as well as in appropriate in-patient settings close to the child’s or young person’s family and home. That is a matter that has been raised many times in this Chamber and one that I am very sympathetic to.
Amendment 22 was tabled by the noble Lord, Lord Scriven, and supported by the noble Baroness, Lady Browning. If taken forward, this amendment would require each local authority to assist the integrated care board in its duties in respect of support registers for people with a learning disability and autistic people. We certainly agree with the intent of this, and I am pleased to be able to provide reassurance that the clause already provides the Secretary of State with the general power to make further provision about the register in regulations. We expect this to include detail on how relevant information is to be obtained and from whom. This is to include the role of local authorities, alongside other relevant health and care bodies, in providing further relevant information.
We believe that it is most appropriate to include this detail in regulations rather than in primary legislation, since the way in which information is obtained, what information is obtained and who might be involved may change with emerging best practice. As noble Lords will realise, that point has been made in respect of a number of these amendments. Returning this to Parliament at every instance would be disproportionate.
However, it is important that the process actively involves health and care system partners. We are clear that the integrated care board must retain overall responsibility for the register. Providing a list of named bodies that have a role in providing information in the legislation may create an unintended diffusion of responsibility, which could negate the benefits of putting these registers on a statutory footing.
Lord Scriven (LD)
I am sorry to interrupt the Minister in mid-flow. She has just explained why it would be wrong to put the process for collecting the data in the Bill, with which I completely agree, but my amendment does not seek to do that. It seeks to make it a legislative requirement of local authorities to be part of the process.
The reason I have tabled the amendment—and I am sure it is the same for the noble Baroness, Lady Browning, in putting her name to it—is that NHS England’s figures say that a lot of people who are admitted to hospital, 52%, are not on the register, but many will have come into contact with the local authority. That is why it is important for the Bill to make local authorities part of the process of identifying who should be on the register. That would subsequently allow the Government to provide statutory guidance about the collection of the data, but it is important that there is a statutory duty in the Bill to do that.
Baroness Merron (Lab)
I thank the noble Lord for adding to the points that he made in response to my comments and the assurances that I have just given, and I am happy to review them. I understand the intent.
Amendments 24 and 29, tabled also by the noble Lord, Lord Scriven, seek to impose a duty on integrated care boards and local authorities to consider information in the register, or obtained by virtue of this clause, when exercising certain existing functions. I strongly agree with the principles behind these amendments, although it is considered that the current drafting in the clause, which requires both integrated care boards and local authorities to “have regard to” the relevant information, already achieves the intended effect. The common duty to have regard is one that both integrated care boards and local authorities are familiar with and used to applying. In this context, we expect this duty to result in careful consideration being given to the information.
Departing from the wording of a well-established duty could create ambiguity, leaving it to the interpretation of individual integrated care boards and local authorities. As I can see the noble Lord agrees, that would be a very undesirable outcome. It may inadvertently create a weaker duty than that set out in the Bill or lead to variation in interpretation and response to the duties.
If Amendments 25, 26, 30 and 31, tabled by the noble Lord, Lord Scriven, were taken forward, they would put a duty on integrated care boards and local authorities to ensure that the needs of people with a learning disability and those who are autistic could be met without detaining them, unless there was a compelling reason why that was not possible. A point was raised, including by the noble Lord, Lord Crisp, about difficulties in enrolment on dynamic support registers and the need to address that in the Bill. DSRs are part of existing NHS England policy and we have heard that they can be effective in preventing hospital admissions. That is why we propose putting these important registers on a statutory footing and making them a requirement.
The Bill already places duties on integrated care boards and local authorities to seek to ensure that the needs of those with a learning disability and of autistic people can be met without detaining them under Part II. This is a legal requirement to ensure that particular attention is paid to the needs of people with a learning disability and of autistic people, and that services should be commissioned accordingly.
Baroness Tyler of Enfield (LD)
My Lords, I thank the Minister for her response. I also thank other noble Lords who have participated in this debate.
For me, the nub of this grouping has been the whole issue of prevention—I think “getting upstream” was the phrase my noble friend Lord Scriven used—and having in place within the community better and more responsive services, with the aim of reducing admissions to in-patient care but, at the same time, improving the in-patient care that is available, because the only people there are those for whom nothing else will work. It is very welcome that the Bill puts the dynamic support register on a statutory footing. On the two amendments from the noble Baroness, Lady Hollins, beefing that up still further, I think I heard a slightly encouraging response from the Minister. I will look carefully at Hansard tomorrow, as I am sure will the noble Lord, Lord Crisp, to see what was said.
I can see that while some people may think that prevention is very important, they would ask what it has to do with this Bill. I do not see it like that. You have to take a system-wide approach. To get the whole mental health service working, even when you are looking at what I call the hard end—the crisis end—you have to look at what is happening at the preventive end and try to reduce the number of people who might need to be admitted. That would send an important message that there are clear legislative requirements for what services should be available within the community. This Bill, frankly, is the obvious place to do it—hence the amendments around children and young people that I raised.
I was pleased to hear the Minister say that the transformation and the 10-year plan will apply at least as much to mental health as to physical health. That is very encouraging and I am glad that we have got it on record. I was not altogether surprised that the Minister thought that my amendments were unnecessary. I do not agree. I was not just talking about children and young people with learning disabilities and autism. They are obviously a very important group, but my rationale for trying to broaden it out to all children and young people was, in essence, to make sure that only those with the most complex needs would receive that higher-quality care in an in-patient setting—everyone would benefit from that approach. The Minister talked about a new approach to children’s and young people’s services, and I look forward to hearing more details. I do not know whether the Minister can tell us when we might expect to see that.
Finally, my view is that the 1983 Act was never really designed with children and young people in mind; I think everyone agrees with that. This Bill is an opportunity for us to put children and young people centre stage—hence my amendment. This is such an important topic that I think we shall be returning to it on Report. On that basis, I beg leave to withdraw my amendment.