House of Lords
Introduction: Baroness Griffin of Princethorpe
Introduction: Lord Wilson of Sedgefield
Colombia: Bilateral Investment Treaty
(1 week, 5 days ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Lord Browne of Ladyton
To ask His Majesty’s Government what assessment they have made of recent comments by the trade minister of Colombia regarding the investor-state dispute settlement provisions in the UK/Colombia bilateral investment treaty.
The Parliamentary Under-Secretary of State, Foreign, Commonwealth and Development Office (Baroness Chapman of Darlington) (Lab)
My Lords, the Government value the UK/Colombia bilateral investment treaty in the investment relationship between our countries. The treaty covered £6.8 billion of bilateral investment in 2023. It provides greater certainty for investors through legally binding investment protection provisions, which ensure that both UK and Colombian investors are protected against unfair and discriminatory treatment and expropriation without adequate compensation.
Lord Browne of Ladyton (Lab)
My Lords, my noble friend will be aware that Colombia seeks renegotiation of the terms of its investment treaty with the UK, concerned—and it is not alone in this concern—that the ISDS provisions are undermining its sovereign democratic right to legislate to protect its indigenous community and environmental rights, or to implement aspects of its national peace plan. In 10 years, it has faced 23 ISDS claims by multinational companies. One was by Glencore mining, prompted by a refusal to authorise the expansion the largest open-pit coal mine—or, if it is not the largest, it is one of the largest—in the world. Last year, we withdrew from the energy charter because of concerns that its ISDS provisions would impede our policy to phase out fossil fuels. It would be somewhat inconsistent to do that while compelling Colombia to abide by similar ISDS provisions in our treaty with it.
Baroness Chapman of Darlington (Lab)
My Lords, as of today His Majesty’s Government have not been formally approached by the Government of Colombia about this, but we are of course always open to hearing the views of our trading partners. Established forums exist for civil society organisations to raise and discuss trade-related issues with government Ministers. Most recently, my right honourable friend the Minister for Trade Policy and Economic Security hosted a civil society round table in December, which included a discussion on ISDS. Ministers will continue to engage with a range of stakeholders, including from civil society, across the full range of trade policy issues, including investment.
Lord Fox (LD)
My Lords, as we have heard, ISDSs are not rare—there are many of them. However, increasingly they are coming under scrutiny and, moving forward, some countries are not seeking them because, as in high-profile cases such as the ones we have heard about, and in others, democratically elected Governments are being challenged and are having to overturn legitimate public policy. Can the Minister tell your Lordships’ House whether she recognises the improper regulatory chill that these agreements can create for democratically elected Governments? Can she set out, in a general sense, the Government’s position for the future? Will the Government continue to seek ISDS agreements in trade deals that they are currently negotiating?
Baroness Chapman of Darlington (Lab)
I am grateful to the noble Lord. I appreciate, as he invited me to, that these agreements stand over a very long period of time. Between an agreement being put in place and 10 years later—which is where we are now with Colombia—at which point there is an opportunity to look at it again, many things may change and it is open to either side to seek changes to the agreement, or to walk away entirely. At the moment, the Colombians have not indicated to us that that is their intention. It should be remembered that these bilateral treaties are helpful in providing assurance to investors, and that is something that we would not want to harm in any way.
Baroness Coussins (CB)
My Lords, as of last year, ISDS claims pending against Colombia exceeded $13 billion. As the penholder for the Colombian peace process at the Security Council, what assessment have His Majesty’s Government made of the impact of this on Colombia’s ability to resource the implementation of the peace accord? How can we leverage our role as penholder to help Colombia achieve this?
Baroness Chapman of Darlington (Lab)
The United Kingdom is absolutely committed to supporting Colombia in the peace process, and enormous progress has been made. We see these things as separate. I think Colombia has faced 26 cases since 2016. Only four of them have been brought by the UK, so we hope that we can continue to trade with Colombia and to invest in Colombia—it is an important partner for us—and to support it as it moves forward with its peace process.
Lord Hannan of Kingsclere (Con)
My Lords, the arguments against the ISDS do not come just from the ecological lobby; there is a democratic argument against them, and there is an argument that they give some foreign companies an unfair advantage over domestic ones. None the less, as the Minister correctly says, they are a necessary way of attracting investment. Can she confirm that, wherever we decide to draw that balance, we should apply it consistently across all our trade deals? It would be neither credible nor sustainable to start changing them because of lobbying from one particular country, which would then encourage every other trading partner to do the same thing.
Baroness Chapman of Darlington (Lab)
I think so—but there is a difference between being consistent and having a cut-and-paste approach. Every context is unique and Colombia is a particularly special partner for us, for reasons that noble Lords will understand.
Baroness Boycott (CB)
My Lords, I declare my interest as director of the Hay Festival Cartagena in Colombia. We will have our 20th anniversary next week, when we will be joined by many politicians, environmentalists and tribal leaders. Perhaps I might extend the question from the noble Baroness, Lady Coussins, about the $13 billion. Australia does not have an ISDS agreement with Colombia. The mega mining group BHP has found a workaround via its UK-registered spin-off company, South32, to sue Colombia for $94 million over alleged unpaid royalties from a mine that the Constitutional Court of Colombia has ruled causes serious long-term health and environmental issues. As the penholder, can we not intervene in this? Colombia has 10% of the world’s unique birds and, just in the last 12 months, it has found 12 new species of plants and an animal, an amphibian, that we did not even know existed.
Baroness Chapman of Darlington (Lab)
Colombia is an astonishing country, not least because of its biodiversity. It would not be right to try to leverage our role as penholder for the peace process at the Security Council to intervene in issues of trade. The UK is the fourth-largest investor in Colombia and we seek to work through these issues alongside Colombia in the spirit of mutual respect and partnership.
Lord Sharpe of Epsom (Con)
My Lords, the Colombian Trade Minister said that the Colombian justice system had the tools to guarantee investors all reasonable protections and due process for the protection of their rights. Have His Majesty’s Government conducted an assessment of the Colombian justice system? If a renegotiation of the agreement takes place, are they satisfied that UK investors’ rights will be guaranteed all reasonable protections? That is particularly important given the ongoing dispute between ViiV Healthcare and the Colombian Government over intellectual property rights.
Baroness Chapman of Darlington (Lab)
The noble Lord opposite is rather rushing his fences. Of course we would look at these things, should there be a formal request for a review or any change from the Government of Colombia, but, as of today, that is not the case. We regularly speak with our partners in Colombia—I was there myself in December—so we would be very happy to have any kind of dialogue that they wish. However, we have not had that request as of now.
Baroness O'Grady of Upper Holloway (Lab)
My Lords, does the Minister recognise that a fatal flaw of the ISDS secret court system is that it privileges big corporations over access and rights for citizens and workers? Can she update us on how the Government are pursuing a trade policy that can be a win-win in providing and protecting jobs and levering up labour standards, recognising that Colombia has a history of being one of the most dangerous countries in the world in which to be a trade unionist?
Baroness Chapman of Darlington (Lab)
I recognise what my noble friend said. I have met with many civil society organisations, including Justice For Colombia, very recently. It is important that these agreements provide a win-win. The UK wants to be a responsible partner with all our trading partners, but—I think it is fair to say—especially with Colombia.
Baroness Bennett of Manor Castle (GP)
My Lords, following on from the last question, the United Nations special rapporteur on the right to development has said that ISDSs are crippling for many countries in terms of the impact on development. They have been described as a form of modern-day colonialism. Does the Minister agree with that? Does she agree that ISDSs are a significant barrier to delivering the sustainable development goals to which the whole world has signed up?
Baroness Chapman of Darlington (Lab)
I certainly would not describe our relationship with Colombia in any way as being to do with colonialism, and Colombia would not, either. We have a respectful, equal relationship of partnership. We have supported Colombia for a very long time, across multiple Governments both here and there, towards its goal of total peace, and that is what we will continue to do.
First-cousin Marriage
(1 week, 5 days ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Lord Farmer
To ask His Majesty’s Government what plans they have to address the health and social impacts of first-cousin marriage, including those relating to women’s rights.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, NHS England continues to drive improvements in care and access to genetic services for all communities, including through research into the health risks of closely related couples—second cousins or closer—having children. In 2024-25, there was an investment of £1 million in the Genetic Risk Equity project, which supports equity of access to genetic services for the small proportion of closely related couples who have a higher risk of having children with certain genetic conditions.
Lord Farmer (Con)
I thank the Minister for that Answer. Pakistani-heritage journalist Matthew Syed has highlighted the risk-multiplying effect of genetic disorders when cousins intergenerationally marry cousins, as happens in remote Shetland, Orkney, and in the British Pakistani community. Pakistanis account for 3.4% of births nationwide but 30% of recessive gene disorders. The NHS employs staff specifically to deal with consanguinity-related diseases. Given this considerable disease burden, and the NHS cost, will this Government mount a health information campaign warning of this significant extra risk?
Baroness Merron (Lab)
I understand the point that the noble Lord is making, but this is a very complex topic in respect of which there is a great lack of reliable data. Any plans for any health information campaign anywhere clearly need to be considered carefully. Perhaps I can reassure the noble Lord that staff from the Genomic Medicine Service are already working with other national projects, such as Born in Bradford and Best Start for Life in Birmingham, to engage with the communities most affected by first-cousin marriage. Of course, any campaign plans for Shetland and Orkney will be a matter for the Scottish Government.
Baroness Brinton (LD)
My Lords, I am grateful to the Minister for referring to the Born in Bradford study because 18 months ago, it reported that over the last decade, the number of intra-cousin marriages in the Pakistani community had substantially fallen. The reasons for this were awareness of the risk of congenital abnormalities, young people staying in education longer, and changing family values. This is clearly a successful project. Is it being replicated elsewhere in the UK?
Baroness Merron (Lab)
The noble Baroness is right that consanguineous unions are decreasing. While it had the best data, the NIHR-funded study, Born in Bradford, to which the noble Baroness and I have referred, found that between 2000 and 2010, 39% of British Pakistani couples in Bradford were first cousins. However, that reduced by 27% by 2019, for the reasons suggested. Driving change across whole ranges of areas makes a difference, but it is important that we keep this in perspective and make any communications and support absolutely appropriate.
Lord Winston (Lab)
My Lords, surely, this Question is an example of the great value of our genetic science in Britain, and the excellence of the National Health Service in this area. In the Midlands, as the noble Baroness has mentioned, these diseases are common, but the progress we have made in their diagnosis and treatment—and, to some extent, prevention—has been quite remarkable and will continue. I have to add that many of the diseases are extremely rare in such families, and therefore what you could do about cousins in every case would be impossible, but the information being given is exemplary in most cases.
Baroness Merron (Lab)
I am grateful to my noble friend for those very informed observations, and I share the assessment that he has made.
Baroness Uddin (Non-Afl)
My Lords, I welcome the reduction in the number of interrelated family marriages, not only in Bradford; the numbers have also drastically reduced in the Bangladeshi community. I understand that countries such as Saudi Arabia have a significant number of first-cousin marriages. In pursuing the suggestions of the noble Lord, Lord Farmer, about a further awareness campaign, can we also learn something from Pakistan, Bangladesh and Saudi Arabia, or anywhere else where this practice exists? Can the Minister confirm whether she has undertaken any discussions internationally?
Baroness Merron (Lab)
I certainly have not, and I am not aware of discussions that have taken place between Ministers or officials in our department and those in other countries. However, I will be very glad to look into that and to write to the noble Baroness.
Lord Kamall (Con)
My Lords, I thank my noble friend Lord Farmer for the Question, and the Minister for the sensitive way in which she is handling it. When we want to look at policy in sensitive areas, surely, we should be led by the data, so I just wonder what the Government’s latest data is. We know that about a decade ago, 6% of congenital defects or anomalies were in children born to first cousins in Pakistani communities, compared to 3% for the wider population. I have seen more recent statistics that say the figures are now 4% and 2%. So, what is the latest data the Government are working with, and what level would those congenital defects have to reach before they were seriously concerned?
Baroness Merron (Lab)
I thank the noble Lord for his support in this area, which is indeed sensitive. The statistics he quotes are quite right. It is of course an interesting reflection that the risk of genetic abnormalities does not just double from 3% to 6% in those infants whose parents are first cousins, but also doubles in older white British mothers—I am a bit worried about saying “older” because it is actually over 34. However, the point is well made that it is not just this group. NHS England has recently published guidance to improve the recording of national data on closely related couples, so I hope that noble Lords will find this of interest as we go along. But of course, there has also been much investment in research as well as data development, and I absolutely agree that data is what has to drive us.
Lord Patel (CB)
My Lords, we know that there are over 6,000 genetically related rare diseases and that, apart from first-cousin marriages, there are other high-risk areas. One, which the Minister just mentioned, is the age of the mother, but this also applies to the age of the father, to people who undergo certain medical technology treatments for fertility reasons, and to mothers who smoke at a higher rate. So, there are lots of other influences that may give rise to genetic-related issues at birth. But the important question is: are there any areas where we can definitively say, “If you do X, Y and Z, or if you do not do X, Y and Z, the incidence of genetic diseases will be reduced”?
Baroness Merron (Lab)
The noble Lord is absolutely right that there is a whole range of factors in this area, and I am grateful to him for bringing that before your Lordships’ House. He will of course be aware of the main pillars in the 10-year plan: for example, moving from sickness to prevention, which is key. The noble Lord also mentioned tackling smoking, which we will continue to drive forward. But I wanted to use the Question to highlight that the NIHR is undertaking research projects into improving early recognition, diagnosis and treatment of specific genetic and congenital diseases, particularly in communities with high rates of marriage between close relations. So, to the specific point, I again hope that that will be helpful.
Lord Foulkes of Cumnock (Lab Co-op)
Will my noble friend have discussions with the Foreign, Commonwealth and Development Office about the data for and experience in some of our overseas territories, particularly Tristan da Cunha and St Helena?
Baroness Merron (Lab)
Yes; that will be extremely helpful in this regard, and I thank my noble friend.
UK/US Free Trade Agreement
(1 week, 5 days ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Lord Hamilton of Epsom
To ask His Majesty’s Government what progress they have made in securing a free trade agreement with the United States.
Lord in Waiting/Government Whip (Lord Leong) (Lab)
My Lords, I congratulate the noble Lord, Lord Hamilton, on securing this timely Question on this very important date in the US. We on these Benches offer our warm congratulations to President Trump on his inauguration. We have a special relationship with our transatlantic partners and strengthening UK-US trading ties is a priority for this Government. I will not get into any policy discussions, but we look forward to working with President Trump and his Administration.
Lord Hamilton of Epsom (Con)
Can the Minister confirm the reports in the paper today that the Government will be anxious to secure a trade deal with the US as quickly as possible? Can he further confirm that that would not be possible if we were still members of the EU? What will happen with the talks that have been pushed on with the European Union? Is there not a danger that one will conflict with the other and that it will not be possible to have a trade deal with the US and the EU at the same time?
Lord Leong (Lab)
I thank the noble Lord for making that important point. In Kyiv last Friday, and at the G20 summit, the Prime Minister said:
“I have been clear that we would like to have discussions about a trade deal with the US, that we don’t accept the argument that there’s a binary choice between a reset with the EU and a deal with the U.S. and obviously the time for those decisions will be in the weeks and months to come”.
The priority of the Prime Minister and the Government is economic growth. Free and open trade with our most economically important partners will be key to achieving that.
Lord Fox (LD)
My Lords, the Question and the Answer illustrate the weakness of our current position. I have also been reading the papers, and we seem to be relying on the sentimental feelings that President Trump may have towards this country, which is a weak position for us. Does the Minister agree with the leader of the Liberal Democrats, Sir Ed Davey, that the best way to negotiate is from a position of strength rather than weakness, and that the best way of bolstering that strength is by establishing a customs union with the European Union?
Lord Leong (Lab)
I thank the noble Lord for his question. We are in a position of strength when dealing with the US and with the EU. There is no question of a binary divide, but we should not take that for granted. We have to work with our partners, and two of our partners are among the biggest trading partners in the world.
Lord Anderson of Swansea (Lab)
Does my noble friend agree that any potential benefits of a trade deal with the US are but a fraction of what we have lost by leaving the European Union? Does he agree that when, under President Biden, we attempted to have a comprehensive free trade agreement, it foundered on two main obstacles—the high food standards which we enjoy and the problem of Northern Ireland—both of which appear still to persist?
Lord Leong (Lab)
I thank my noble friend for that question. The US is our single largest trading partner, amounting to well over £300 billion last year. We have invested close to £1.2 trillion in both our economies, and employ almost 1 million people. The US is a country that we have to deal with, and our businesses ask us to work with the US.
Lord Stirrup (CB)
My Lords, clearly President Trump will link his economic relations to wider policy objectives. One of the policy objectives that he will be looking for in this country, as well as in others within Europe, will be for European nations to take a much greater share of the burden for their own security. At present, this country and other European partners are doing that far too little and far too slowly.
Lord Leong (Lab)
I thank the noble and gallant Lord for that question. I do not think we should get ahead of ourselves. The President is being sworn in at this very moment. We will be looking towards working with his Administration. Any discussions about defence or trade will have to wait until his Government get in.
Baroness Jones of Moulsecoomb (GP)
My Lords, are the British Government going to take any extra security precautions when they are dealing with the President of the United States, who is a convicted felon?
Lord Leong (Lab)
I thank the noble Baroness for the question, but I do not agree with her. We have to respect President Trump. He won an enormous victory and he has a massive mandate from the American people. That is democracy. We will work with President Trump and his Administration.
Lord Dobbs (Con)
I wish the Government well in their attempts to get a free trade deal with the United States, but is it not time for a little joined-up thinking? While the Prime Minister says this is what he wants, over the weekend the Labour Mayor of London insisted on calling President Trump, essentially, a fascist, and said that we are on the road to the 1930s. This is not a special relationship—they are turning it into a sack of ferrets. Do the Government agree with the Labour Mayor of London, or will they repudiate the comments that he made over the weekend?
Lord Leong (Lab)
The noble Lord makes a very important point. I disagree with the Mayor of London. President Trump won the election; he has an enormous mandate, and we have to work with him. Sometimes, a period of silence would be most welcome.
Baroness Goudie (Lab)
My Lords, would the Minister join me in congratulating our ambassador, Karen Pierce, on her persistence and leadership in trying to get a free trade agreement over a period of some years? She worked with the team in the American embassy, with consuls around America and everywhere that she could influence Americans to gain us support. We hope very much that the noble Lord, Lord Mandelson, our new ambassador, with his skills from his time as a trade commissioner in Europe and his other contacts, will be able to continue giving such leadership to the team in Washington and here.
Lord Leong (Lab)
I thank my noble friend for that question. The appointment of my noble friend Lord Mandelson as the UK’s ambassador to the US shows how seriously we take our relationship with the US and the incoming President’s team. My noble friend Lord Mandelson has extensive foreign and economic policy expertise, particularly in the crucial issue of trade, with strong business links and experience at the highest level of government.
Lord Sharpe of Epsom (Con)
Can the Minister say who from this House or the other place is representing His Majesty’s Government at President Trump’s inauguration, and whether they will be having high-level conversations about trade and other matters with the new Administration?
Lord Leong (Lab)
I thank the noble Lord for that point. Our ambassador in the US will be representing the Government.
Lord West of Spithead (Lab)
My Lords, I spent 60 years closely involved with defence and intelligence with the United States. Does my noble friend the Minister agree that the strength of the relationship is so immense that we should never forget that, even when it comes to these other issues?
Lord Leong (Lab)
I thank my noble friend for that point—it is absolutely true. As I said, our relationship with the US has to be strong. We have so many partnership agreements, whether it is on defence, trade co-operation and so on, so we have to work with the incoming Administration, come what may.
Lord Hannan of Kingsclere (Con)
My Lords, the US is not just our single biggest market; it is bigger than our second, third and fourth markets put together, and nearly as big as our second, third, fourth and fifth put together. A million Brits turn up every day to work for US-owned companies, and a million Americans turn up every day to work for British-owned companies. Will the Minister confirm that, if we followed the suggestion of the Lib Dem Front Bench and joined the EU customs union, not only would we not be able to negotiate a trade deal, either with the US or with anyone else in the world, but we would be subjected to all the tariffs that Trump is likely to impose on the EU in return for no benefit whatever?
Lord Leong (Lab)
I thank the noble Lord for that question. We have taken back control. We work with the US, the EU and every other country. We are an open trading economy, and that benefits both our businesses and consumers.
Baroness Chakrabarti (Lab)
My Lords, even though the United States is a great constitutional democracy, could my noble friend the Minister reflect on the previous Question about ISDS arrangements and make sure that any trade deal between our two great democracies does not privilege international corporations over citizens or workers, and respects both democracy and the rule of law?
Lord Leong (Lab)
I thank my noble friend for the question. No two trade agreements are the same, and ISDS is only one chapter in any trade negotiation. We have to negotiate for what is best for our country and for business.
Erasmus Programme
(1 week, 5 days ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Lord Balfe
To ask His Majesty’s Government what steps they are taking to fulfil demand for the revival or replacement of the Erasmus programme.
The Minister of State, Department for Education (Baroness Smith of Malvern) (Lab)
My Lords, following the UK’s departure from the EU, the Government introduced the Turing scheme in 2021, which provides grants for students to study and work anywhere in the world and has supported tens of thousands of UK students since its launch. In addition, we are working with the higher education sector to ensure that our world-leading universities continue to attract the brightest and best. However, we have no plans for rejoining the Erasmus programme.
Lord Balfe (Con)
My Lords, the EU clearly wants a new EU mobility scheme for youth, and there is a great demand for that among young people in Britain. It would strengthen our society, labour market and economy, so why do the Government—as did, in fairness, the previous Government—seem so hell-bent on avoiding any commitment to a European solution?
Baroness Smith of Malvern (Lab)
We are, of course, already engaged in defining the important reset of our relationship with the EU. That is why the Prime Minister and the European Commission President met in the autumn to agree to strengthen our relationship. My right honourable friend, Minister Thomas-Symonds, has been taking discussions forward with his counterpart. We will look at EU proposals on a range of issues, but there are no plans for a youth mobility scheme and we will not return to freedom of movement.
The Earl of Clancarty (CB)
My Lords, does the Minister agree that a critical advantage of Erasmus is reciprocity, which is lacking in the Turing scheme?
Baroness Smith of Malvern (Lab)
The Turing scheme focuses on ensuring that UK students in higher education, learners in further education and school pupils are able to take advantage of studying or working abroad. I am encouraged that, of those taking part in the scheme in 2024-25, 53% are from disadvantaged backgrounds. The focus remains on providing opportunities for UK students to experience the benefits of studying and working abroad.
Lord Wigley (PC)
My Lords, the Minister will be aware of the scheme that has been running in Wales with the support of all parties there. None the less, I think there is an acceptance across parties in Wales that the full Erasmus scheme was much more beneficial for everybody in both directions. The reopening of it would not necessarily prejudice the attitude towards other questions relating to the European Union. Surely the Government can make an example of this one to get progress in its own right.
Baroness Smith of Malvern (Lab)
I am not sure that, if you are engaged in a quite important reset as the UK Government are, it makes enormous sense to pick and choose the different issues on which you might negotiate. I acknowledge the noble Lord’s recognition of Taith, the Welsh Government’s international learning exchange programme, which, like the Turing scheme, provides important opportunities.
Lord Addington (LD)
My Lords, David Lammy said that he wanted to reinvigorate our relationship with the EU. Would not the Erasmus scheme, or something very like it, be a good step towards that?
Baroness Smith of Malvern (Lab)
We are already resetting our relationship with our European friends, to strengthen ties, to secure a broad-based security pact and to tackle barriers to trade. The President of the European Council has invited the Prime Minister to meet EU leaders in Brussels on 3 February, where the Prime Minister is looking forward to discussing enhanced strategic co-operation with the EU. We are also resetting our bilateral relationships alongside our ambition for our wider reset with the EU, as demonstrated by the Prime Minister’s recent visits to France, Germany, Ireland and Italy.
Lord Hannay of Chiswick (CB)
My Lords, will the Minister tell us why the Government have no plans to join Erasmus? She has stated flatly that we do not have plans to, but why not, when the Erasmus scheme was recognised by both main parties when in government as one of the major advantages of being in the EU?
Baroness Smith of Malvern (Lab)
The Erasmus scheme may well have been a major advantage, but we had to leave that scheme at the point at which we left the EU in 2020.
Lord Forsyth of Drumlean (Con)
My Lords, did I imagine it or, when the Labour Party was in opposition, did we not hear endless questions condemning the previous Government for not joining Erasmus? What has brought about this change of mind? Has the penny finally dropped that, as the Minister answering the previous Question said, it is better to take back control?
Baroness Smith of Malvern (Lab)
As I have just said, there were considerable benefits to being part of the Erasmus scheme, but of course the UK ceased to participate in Erasmus as a programme country after leaving the EU on 31 January 2020—a decision for which this Government were not responsible, but we need to clear up the mess.
Lord Anderson of Swansea (Lab)
My Lords, what is the objection in principle to having youth exchanges as part of a reset?
Baroness Smith of Malvern (Lab)
It is important that we provide opportunities for our young people to study and work abroad. That is what the Turing scheme is currently doing, to an extent. I am pleased that in the past year it ensured that disadvantaged students in particular were able to take advantage of it. As I have already said, as part of our reset, we will consider in the round any proposals that we believe to be of advantage to our country and to our young people.
Baroness Smith of Newnham (LD)
My Lords, does the Minister understand that the idea of Erasmus is not simply about British students going to other countries but about a genuine exchange at the stage in life when it can fundamentally change people’s experiences and help the United Kingdom in future? It is a form of soft power and would be beneficial whether as part of a wider reset or not, whatever one’s attitudes to the European Union may be.
Baroness Smith of Malvern (Lab)
I understand that, and I understand the benefits that come, for example, to our higher education sector from international students coming to the UK. That is why the Government have set out the valuable contribution that international students make to our universities, our communities and our country—and, of course to our economy in terms of the £12.1 billion fee income that comes from those students. I wholly understand the noble Baroness’s point. That is why I hope that, in future, we will be able to build on that to ensure that people can come to the UK to benefit from our education system.
Baroness Barran (Con)
My Lords, perhaps I can give the Minister a little relief from talking about Erasmus by talking about the Turing scheme itself. Yesterday, the DfE published the updated guidelines for Turing applicants for 2025-26, which appear pretty much identical to those published under the previous Government. Can she confirm that the funding will be maintained for this year? Given how oversubscribed Turing is, will there be any shift in priorities between schools, colleges and universities?
Baroness Smith of Malvern (Lab)
I am pleased that we are able to continue the Turing scheme for the coming year, with £105 million allocated this year. I will come back to the noble Baroness on the allocation for next year. My wish is that we make even further progress than has been the case this year on ensuring that those who can benefit from it are participants from disadvantaged backgrounds, who would not otherwise have that opportunity.
Lord Berkeley of Knighton (CB)
My Lords, I certainly welcome the Turing scheme, but it is not the same thing as Erasmus. The important thing about Erasmus is that it is not just about education; as we have heard, it is about the wider cultural exchange of ideas. With respect, I do not think that the Minister answered my noble friend Lord Clancarty’s question about reciprocity. We do not accept people from abroad. Is that not surely the whole nature of an exchange of ideas?
Baroness Smith of Malvern (Lab)
I talked about the considerable benefits that come to our country and our higher education system from the ability of international students to come to study in the UK. We are also committed as a department to ensuring school visits and other opportunities for exchange. We can, where possible, eradicate some of the challenges that have arisen in relation to children going to experience visits in the rest of Europe and to students being able to come to the UK. Of course, we recognise the benefit that comes from language assistants, for example, being able to come to the UK. I do not think it is true that I have not recognised that, but that is different from committing to a specific programme at this point in the UK’s reset with the EU.
Restoration and Renewal Programme Board
The Senior Deputy Speaker
That Lord Mackinlay of Richborough be appointed a member of the Programme Board, in place of Lord Greenhalgh.
Reporting on Payment Practices and Performance (Amendment) (No. 2) Regulations 2024
Lord Leong
That the draft Regulations laid before the House on 7 October 2024 be approved.
Considered in Grand Committee on 13 January.
Lord in Waiting/Government Whip (Lord Leong) (Lab)
My Lords, on behalf of my noble friend Lady Gustafsson, I beg to move the Motion standing in her name on the Order Paper.
Motion agreed.
Non-Consensual Sexually Explicit Images and Videos (Offences) Bill [HL]
Monday 20th January 2025
(1 week, 5 days ago)
Lords ChamberRead Full debate Non-Consensual Sexually Explicit Images and Videos (Offences) Bill [HL] 2024-26 View all Non-Consensual Sexually Explicit Images and Videos (Offences) Bill [HL] 2024-26 Debates Read Hansard Text
Baroness Owen of Alderley Edge (Con)
My Lords, I understand that no amendments have been set down to this Bill and that no noble Lord has indicated a wish to move a manuscript amendment or to speak in Committee. Unless, therefore, any noble Lord objects, I beg to move that the order of commitment be discharged.
Motion agreed.
Public Authority Algorithmic and Automated Decision-Making Systems Bill [HL]
Monday 20th January 2025
(1 week, 5 days ago)
Lords ChamberRead Full debate Public Authority Algorithmic and Automated Decision-Making Systems Bill [HL] 2024-26 View all Public Authority Algorithmic and Automated Decision-Making Systems Bill [HL] 2024-26 Debates Read Hansard Text
Lord Clement-Jones (LD)
My Lords, I understand that no amendments have been set down to this Bill and that no noble Lord has indicated a wish to move a manuscript amendment or to speak in Committee. Unless, therefore, any noble Lord objects, I beg to move that the order of commitment be discharged.
Motion agreed.
Child Sexual Exploitation and Abuse
(1 week, 5 days ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Davies of Gower (Con)
My Lords, the horrific crimes of child sexual exploitation and abuse laid bare in the Home Office Statement are a particularly dark moment for our nation.
Let us not mince words: local authorities run by Labour have failed to act with the urgency that these crimes demand. Last week, the Prime Minister referred to those calling for a national inquiry into the scandal as “far-right”. Let us be clear: there is nothing far-right about wanting justice.
It seems that the general public agree. Two-thirds of Labour voters are at odds with Sir Keir Starmer and would support a new statutory public inquiry into the grooming-gangs scandal. New YouGov polling suggests that 76% of the British public— including 65% of Labour voters—would support a new statutory inquiry, compared with just 13% who would oppose a new national investigation. This is a moment where the Government could have truly united the nation by listening to His Majesty’s loyal Opposition, but they have failed to do so.
While I welcome the recognition of grooming gangs as a persistent and insidious threat, the Government’s measures fall short of what is needed. The ethnicity data expansion and rapid audits do not go far enough. Prominent voices have long called for robust data collection and enforcement to identify and dismantle these criminal networks.
Under Labour’s watch in council areas such as Rotherham and Oldham, local authorities and police forces have been complicit in a culture of excuses and cover-ups. Instead of demanding transparency and accountability, this Government are tiptoeing around hard truths, putting political correctness above child protection. We must confront the uncomfortable realities of this crisis, including the cultural and societal factors that enable abuse.
Local inquiries, while helpful, are no substitute for national leadership. The £5 million funding for local initiatives is a drop in the ocean compared to the scale of the problem. What Labour fails to grasp is that piecemeal solutions cannot address systemic failures. What is required is a unified, national strategy that holds all institutions accountable and ensures no child slips through the cracks.
This Government need to understand that this issue is a national emergency. I repeat that the Government need to launch a comprehensive national statutory inquiry, holding those responsible to account. Most importantly, we need to deliver justice for survivors through action. It is not enough to audit failures; we must correct them.
The safety of our children is not a partisan issue; it is a moral obligation. Yet, the Government’s record on this crisis has been one of hesitation, inaction and misplaced priorities. We as an Opposition will not stand by as these failures persist. We owe it to the victims, the survivors and the generations to come to build a society that will no longer look the other way. This is the leadership our nation deserves: firm, unapologetic and unwavering in its commitment to protecting the innocent.
Baroness Brinton (LD)
My Lords, from these Benches, I pay tribute to the victims of child sexual exploitation who, for too long, have been treated as miscreants themselves, including by police and social workers, thus repeating their victimisation. Their bravery in continuing their fight over many years of not being listened to is quite extraordinary.
My first question is about them. What support and recompense will the Government provide for these victims? While it is good that the Government have accepted all the IICSA recommendations, the Statement says that the Government will lay out a timetable for taking forward these recommendations before Easter. A timetable is welcome, but does the Minister actually have any idea of timescales for the possible start and finish for the discussion, consultation and implementation of these recommendations? I ask this with experience of speaking on many of the other inquiries and recommendations, and know how easily things can get bogged down in paperwork, to put it politely.
The Home Secretary said that there will be
“new action to help victims get more investigations and prosecutions”.
However, I cannot get the answer to my question of why the Victims and Prisoners Act 2024, which incorporates an enormous amount of legislation to support victims, has not yet been commenced, other than for the Infected Blood Compensation Authority.
The HMICFRS inspection on police and law enforcement bodies’ response to group-based child sexual exploitation in England and Wales, published in December 2023, made nine recommendations. Can the Minister say how many have now been fully implemented by government? It is not clear whether the previous Government had accepted them in full, let alone implemented them. I realise that three have not quite reached the deadline by which that should have been done—only one of those goes beyond March this year—but that leaves six where the deadline has now passed. If the Minister cannot answer that question now, I would be grateful if he could write to me.
It is encouraging that the Government want to do a rapid audit of the current scale and nature of gang-based exploitation, but can he say what “rapid” means, not least as the noble Baroness, Lady Casey, has other roles to fulfil? Will her taking up this role slow down the other important work that she is doing?
It is also encouraging that the Government will start collecting better data and evidence. One of the problems here is that a lot of the evidence has never been collected. Can the Minister say whether they will review the various local inquiries—Oldham, Rotherham, Telford and other towns? I have raised this with him before, and I got a positive response, but it would be useful if the Government could lay out all the various inquiries that have happened so that it is possible for their information to be included; otherwise, we may miss some important things.
It is good news that Tom Crowther KC has been appointed to develop a new framework for victim-centred locally led inquiries. The Statement mentions the drawing up of a duty of candour. We on these Benches have stood alongside Labour when it has raised this is the past. Can the Minister give your Lordships’ House some idea about when this might be published? There is clearly an urgent need for it.
I end by expressing my disappointment at the contribution made by the noble Lord, Lord Davies of Gower. He talked about the national emergency, but his Government did not accept all the recommendations made by Alexis Jay, it is not clear whether they have implemented the recommendations from HMI, and, more importantly, his Government did nothing to start to implement those that his party now says should have been implemented.
Lord Hanson of Flint (Lab)
I am grateful for both Front-Bench contributions. I say at the outset that I am disappointed by the tone of the first few words spoken by the noble Lord, Lord Davies of Gower. He seems to imply that this problem occurs only in authorities that have Labour control. If he thinks that is the case, he is sadly misguided. When he reads back what he has said today, I think the tone of his contribution is one that he will think about, reflect upon and regret.
I am trying to look at a programme of activity to ensure that we stop the vile crime of child abuse, that we respond to the reports that have been published already, and that we put a detailed programme in place to affect change. I am disappointed by the way that the noble Lord has approached this. If he wants to politicise things, let us politicise the Alexis Jay report, rightly commissioned by the noble Baroness, Lady May, when she was in the House of Commons. It took seven years to achieve its objectives and produce recommendations, which were given to the previous Government in May 2023. By 4 July 2024, not one single action in the recommendations had been started, never mind completed. So if the noble Lord wants to politicise this matter, I will certainly politicise it, but I appeal to all Members of this House to focus on the real issue: child abuse and prevention of that child abuse.
That is why I will focus on the contribution made by the noble Baroness, Lady Brinton. I can tell her that there will be a clear timetable. There will be a clear programme of activity. We have said that, unlike the previous Government, we will respond to all 20 IICSA recommendations by Easter of this year. We have already put in place three recommendations announced recently by my right honourable friend the Home Secretary in the House of Commons. Those three steps include: mandatory reporting, which we debated in depth on Friday; making grooming an aggravated factor, which I know the noble Baroness will welcome; and introducing police performance frameworks, which again I know the noble Baroness will welcome.
The noble Baroness asked about the Victims and Prisoners Act. I have consulted my noble friend Lord Ponsonby, the Justice Minister, and we are working on that; we will bring forward proposals to implement that in due course.
The noble Baroness asked about deadlines, the Casey report and our response. The noble Baroness, Lady Casey, has been commissioned to do a short report for three months to take us up to April. She does not commence the longer-term work on other departments’ activities until April this year. The three-month audit is about looking at the issues, which are important in all local authorities, of the ethnicity of people who are committing child abuse, what preparation is available and what support is on hand.
The noble Baroness, Lady Brinton, asked about all inquiries. She knows that I have given a commitment before that we need to look at the lessons from all inquiries, but I say to all Members of this House that we have laid out a clear timetable for implementing the IICSA recommendations; we have appointed the noble Baroness, Lady Casey, to improve the understanding of the scale and nature; we have extended the remit of the IICSA report to look at other areas now; we have given support to the National Police Chiefs’ Council to look at further action that could be taken on historic child sex abuse reviews; we have put finance in of £5 million, not just with Tom Crowther but with others, to look at local inquiries; we have put an undercover online help and support line in place; we have included the three mandatory duties; and we will be taking measures on the Online Safety Act, which will come into effect next year, to make sure that we tackle child sexual abuse, which very often is now on the dark web and online.
I offer the noble Lord the hand of friendship and ask him not to politicise this in the way that he has and to look at the positives that have been done.
Lord Hanson of Flint (Lab)
A statutory inquiry, for which the noble Lord heckles me from a sedentary position, would mean a further five or six years before recommendations took place. Clear action was set down by Alexis Jay in the IICSA inquiry.
Believe it or not, we have been working on this from last July to January this year. We have announced measures now because parties have commented, often based on false information, about what has not been happening. Things have been happening. Those who have served or worked in government know that Governments do not just announce things at one day’s notice. A lot of work has been put into this between July and January to achieve those objectives—and in fact we have put an awful lot more work into this than the previous Government did over the 19 months when those recommendations were there.
So my hand of friendship goes to the noble Lord, Lord Davies. He should work with the Government, with Members of the Liberal Democrats, with this House and with the House of Commons to do something now, in the next few months, to help to reduce the dreadful activities of child abuse online, in person and elsewhere. If we do that, we can make a real difference in the near future rather than waiting for some mythical inquiry and trying to pin the fact that we cannot do that on the Government because of political shenanigans. We are not doing that because we want urgent action on this issue. I commend my right honourable friend’s Statement to the House.
Baroness Butler-Sloss (CB)
My Lords, I spent almost all my legal and judicial life on child sexual abuse and child physical abuse, and I chaired the Cleveland child abuse inquiry. I agree entirely with what the noble Baroness, Lady Brinton, has said and with much of what the Minister has said. I suggest to the Government that now is not the moment to have a full statutory inquiry. What is crucial is to have the recommendations of all the earlier inquiries implemented as quickly as possible. A statutory inquiry at this moment—whether we need it later is another matter—would impede the Government from getting on with what needs to be done.
I was lucky because many of my recommendations were actually accepted, but one of the shocking aspects of our endless statutory inquiries is that that is unusual. We have a history across this country of statutory and other inquiries with endless excellent recommendations, almost none of which are taken up. This is the moment—on a subject of excruciating importance, where there are so many victims across the country—to see that something is done, not talked about.
Lord Hanson of Flint (Lab)
The noble and learned Baroness has committed a large part of her professional life to tackling this issue, and I take very much to heart her support for the Government’s stance on a statutory national inquiry. We are not doing that for the reasons I explained to the noble Lord, Lord Davies: in essence, we would waste time looking at a problem in respect of which we already have 20 recommendations from IICSA, and other recommendations from earlier reports, which is why my right honourable friend the Home Secretary has accepted all the Home Office recommendations for implementation now. The remaining recommendations for other parts of government will be brought forward prior to Easter. We have given a clear timetable. I will be held to account by this House, as will my right honourable friend by the House of Commons. We are here to deliver on the recommendations. I say to the House again that the recommendations were delivered in May 2023. On 4 July, when this Government came into office, not one single inch had been moved towards those recommendations. That is this Government’s focus. By all means let us have a political debate about it, but I am more interested in taking action which will help prevent there being future victims.
Baroness Foster of Aghadrumsee (Non-Afl)
My Lords, I welcome the focus on the victims, which is critical; sometimes we forget about the victims when we debate points of process. At the end of the Statement, the noble Lord’s right honourable friend referred to undercover online networks and the need to engage on that, because we know that what happens online, unfortunately, quickly moves into reality. Reducing the number of online pathways that accelerate harm should be a priority as well. There are plenty of priorities, I accept that, but surely this has to be one. Will the Minister commit to working with experts in this field—including the former head of CEOP, Jim Gamble, who he will be familiar with and who did some excellent work with the former Government—to really take on this issue? It concerns me that it becomes a reality when it starts online.
Lord Hanson of Flint (Lab)
The noble Baroness, Lady Foster, knows that I have great respect for Jim Gamble and his work. She will also know that addressing the movement to online presence, the dark web, fake images, AI, and the future development of child abuse in that sphere is extremely important for the Government. That is why two things are happening as a result of my right honourable friend’s Statement. The first is action on the Online Safety Act to try to look at how we tighten up laws on the use of child images and child abuse images online. Secondly, we are recruiting a large number of additional online undercover police officers. I do not need to talk to the House in great detail about that, but the purpose of those officers is to capture people who are committing criminal activity online and bring them to justice in order to stop them exploiting young people and children, and to stop young people and children being exploited through providing images that those people will seek to use. They are both extremely important areas that the Government are focused on.
Baroness Berridge (Con)
My Lords, I had the duty to give evidence to IICSA in my time as a Minister, and then served on the Select Committee that looked at statutory inquiries. We came up with a recommendation that was in line with what the noble and learned Baroness, Lady Butler-Sloss, said about enacting recommendations. We heard evidence, though, that, in addition to its recommendations, a really important part of IICSA was the Truth Project. Of some 7,000 victims who took part, about 6,000 were within that project, which was nowhere near being a core participant. Can the Minister outline how reviews of local inquiries will not lose sight of the fact that victims really valued that process, which was very cathartic and not part of the judicial process of the inquiry?
Lord Hanson of Flint (Lab)
I am grateful to the noble Baroness, Lady Berridge, for those comments. I think she will know that the Government want to put victims at the heart of the response to the recommendations. We debated mandatory reporting on Friday in this House, and it was clear that victims carry the pain of their victimhood through into adult life and beyond. It scars individuals. My noble friend Lord Mann mentioned the many victims who do not reach adulthood because they self-harm and commit suicide. We need to address how we involve the experience of victims to ensure we do not create future victims. I see the noble Baroness, Lady May of Maidenhead, in her place. The inquiry she established had a number of recommendations on how we can help support victims, and we will look at those between now and Easter. It takes time, but we will look at how we can respond to those recommendations in the best way, so as not to lose the knowledge that the noble Baroness, Lady Berridge, mentioned.
Lord Mann (Lab)
My Lords, process is clearly very important in relation to statutory inquiries and to giving the recommendations some kind of parliamentary scrutiny and holding them to account. On Friday, the Minister identified that the Home Office was responsible for “four” of the 20 recommendations. Which member of the Cabinet will be responsible for leading on this inquiry and its recommendations? Will the Minister take it from me that there would be a lot of delight—widely across the House, I suspect—if he were to take responsibility among Ministers in this House for leading on reporting back progress on this inquiry?
Lord Hanson of Flint (Lab)
I say to my noble friend that my right honourable friend the Prime Minister takes a keen interest in the progress of these reports, and he will monitor and hold to account Ministers in government on that delivery. But the very fact that I am standing here today, and that my right honourable friend the Home Secretary was standing in the House of Commons, shows that we are responding on behalf of the Government to the IICSA response. That is where the lead and responsibility lie: with the Home Office. But we do not have the direct implementation of a number of recommendations, which require the engagement of the Department for Education, the Department of Health and Social Care, and other departments. We have set out the timetable to meet those 17 other recommendations; we have accepted the four, and we are already implementing some. Very shortly, other legislation will be published by the Home Office that will give effect to the recommendations we have accepted. It is our job to see that through and to do so, I hope—putting out the hand of friendship—with the support of the Opposition Front Bench.
Baroness Benjamin (LD)
My Lords, I congratulate the Government on taking this robust approach in order to make a real difference and change for our children’s lives—the victims will carry that pain through childhood and beyond. The introduction of any duty to report child sexual abuse and exploitation must be accompanied by funding for services and training to support practitioners working with children across the country. Essential services like the NSPCC Childline and the Shore service play a vital role in supporting children who have suffered child sexual abuse and exploitation. How will the Government ensure that these services will be able to continue their valuable work?
Lord Hanson of Flint (Lab)
I am grateful for the noble Baroness’s support for mandatory reporting. She participated in the debate on Friday and will know that I said from this Dispatch Box that this is an urgent issue for this Government. We will bring forward proposals on mandatory reporting in very short order. She raises the issue of funding. Any implementation of any recommendations requires a consistent government approach and a review of how we are funding those approaches to those issues. I cannot give her a detailed answer now, but, as part of the review on what we do with the 17 other recommendations, we will put meat on those bones so that she and others in this House can see what resources the Government are putting into this area.
The noble Baroness raises the issue of the very important support of the voluntary agencies. It is important that, politically—I mean that in a non-party-political way—we give support to Barnardo’s, the NSPCC and other organisations, which are doing great work in both highlighting this terrible abuse and very much supporting development work on the ground. This is helping the Government’s case to reduce the amount of child abuse as a whole. So I cannot give that answer now, but I will return to this in due course.
The Lord Bishop of St Edmundsbury and Ipswich
My Lords, I also pay tribute to victims and survivors in this regard, recognising that the failure to respond perpetuates and prolongs their suffering, and recognising—as noble Lords will all know—that the Church of England is facing significant challenges in putting its own house in order in that regard. I want to ask, therefore, a wider question on faith communities, all of which provide places of gathering and moral and social influence, and all of which strive to make those places as safe as possible. What conversations are continuing with leaders of faith communities to support them in that vital work?
Lord Hanson of Flint (Lab)
I welcome the right reverend Prelate’s contribution. I think I can say to him that the Church has had difficulties, which he has acknowledged, and those difficulties might well have been resolved had some of the measures in the IICSA report been in place at the time. For example, had mandatory reporting been in place seven or eight years ago, it is very possible that some of the concerns that have arisen in the last few weeks and months in relation to the reporting of sex abuse in the Church might have been resolved.
I reach out to the right reverend Prelate, as I reach out to teachers, social workers and others who have a place of responsibility for the safeguarding of children, to say that the measures in the IICSA report, following the helpful inquiry led by Alexis Jay, are in areas where I hope we can work in co-operation with any authority, be it the Church, teachers or others, to see whether they impact upon the areas where the right reverend Prelate and his colleagues have had concerns.
Lord Laming (CB)
My Lords, the Minister has the whole House with him when he agrees that we must do very much better in preventing the sexual abuse of children. That is the challenge. We actually know how to do it and we could do it very much better. Much on my mind is the list of local authorities, published yesterday and again today, that are on the verge of bankruptcy. That means that services are being withdrawn at the very time when we want services to be outward-looking and more engaged, especially in preventing children being abused in this way.
Lord Hanson of Flint (Lab)
The noble Lord has experience far beyond any that I could bring to this House, so I am grateful for his contribution today. He raises an extremely important point. We have established a fund—it is of only £5 million, but it is available to all local authorities to draw on to establish the work that needs to be done. That was in the initial announcement from my right honourable friend in the House of Commons last week and will be kept under review for the future. We have given the noble Baroness, Lady Casey, a remit to look at the existing areas of concern within local authorities. No doubt she will come back with an audit and further recommendations for the Government to consider.
I recognise that the noble Lord has concerns about long-term funding for key services that are about interventions. I can say to him only that we are going to keep all that under review. I know I will have his support, and that of others with great experience, in implementing the IICSA recommendations and when we bring back proposals on the other recommendations, in what might be only 10 weeks’ time.
Baroness Falkner of Margravine (CB)
My Lords, I declare an interest as chair of the Equality and Human Rights Commission, although I am speaking in a personal capacity today. About a week ago, when the Minister and I engaged on a similar but different Statement, I asked him two questions and he said he would need to go away and think about them. One was about data. I do not know whether he has seen the reports, based on freedom of information requests, about backsliding. I very much welcome the emphasis on ethnicity data collection and demographics, as the Statement says. Has he seen the statistics? I will give him only three examples. In Hampshire, in the past five years, 58% of offenders sentenced for all sexual offences involving children were recorded as having an unknown ethnicity. In West Mercia, it was 55%, and in Leicestershire, it was 52%. If the police are already not recording identity for fear of being accused of either racism or Islamophobia, what are the Government going to do, before we get the full gamut of actions under the Jay report, to ensure that the current requirements are met?
Lord Hanson of Flint (Lab)
The noble Baroness had a conversation with me, both in this Chamber and outside. She will know that there are occasions when Ministers can absorb views but cannot necessarily give definitive answers, because policy is developed outside of just the discussions in this House and in government as a whole. I hope she will welcome that one of the policy initiatives in the second Statement made by my right honourable friend the Home Secretary was the collection of data—the very point she raised with me before we made that announcement. I could not give her assurances then because we had not made the announcement; now we have. That data will be collected by the noble Baroness, Lady Casey. If it shows matters that need to be addressed, they will be addressed, to try to reduce this curse.
Baroness Fox of Buckley (Non-Afl)
My Lords, the culture of denial and cover-up that has led to this scandal has over recent years often happened by attacking people’s tone. Can the Minister comment on the row in Wales, where, last week, the Presiding Officer of the Senedd denied that Wales had a grooming gangs problem and accused Darren Millar, who raised it, of being overly graphic and using the wrong tone when describing one girl’s ordeal, leading to that victim saying that she feels her experience was downplayed? Surely tone is not the problem at all—though the Minister started off by saying that it was. Can the Minister explain how five local inquiries can deal with ongoing problems in at least 50 towns in the UK and why witnesses cannot be compelled to attend? It feels inadequate, and that is what many victims are saying.
Lord Hanson of Flint (Lab)
I am responsible for many things in this department but I am not responsible for the comments of the Senedd Presiding Officer or any spat that they may have had with the leader of the Conservative Party in Wales in the Senedd. That is a matter for them. I can say that tone is important. I have tried to have an inclusive tone in this House in response to the recommendations. I put down my disappointment at the initial comments and tone of the Front Bench of His Majesty’s Opposition, which, in my view, tried to politicise what should be a contribution from all parties and none in this House to implement the recommendations of the IICSA report.
The noble Baroness mentioned the five authorities we have looked at. Those are the five where there have been reports to date. We are doing what I have been asked to do by Members of this House, which is to see whether all recommendations have been implemented to date. I have been asked by Members to look at ethnicity and other issues around who is undertaking this, which is why we have asked the noble Baroness, Lady Casey, a Member of this House, to do a very quick deep-dive audit of what is happening. We are trying to address that. On top of that, we are still trying to get to the key point: what do we do about the 17 recommendations that the previous Government did nothing about? That is what I am trying to focus on today. I will take any contribution from any part of this House to set a tone to deliver on those recommendations.
Lord Paddick (Non-Afl)
My Lords, to what extent are these failings the result of victims of child exploitation and abuse not being believed? With the case of Jimmy Savile, for example, we saw that victims were not believed by the police. There is a lot of emphasis on the ethnicity of the perpetrators, but would the Minister agree that there is not enough emphasis on the police not believing victims because of their background, age and lack of education?
Lord Hanson of Flint (Lab)
That very point, which was well made, is why, on Friday, the Government accepted the principle of mandatory reporting and will bring forward legislation shortly. Mandatory reporting means that, if a member of the Church, a teacher, a social worker, or somebody in a position of authority has a report made to them by anybody, be it a perpetrator or a child, about a suspicion of child sexual abuse, that has to be referred to the appropriate authority. Therefore, the police will have a greater impetus to investigate such reports than perhaps some forces or officers have undertaken in the past. It is not now just about the belief of a child; it is about the belief of a report being made by an individual in a position of authority to say that this needs to be investigated. That does not imply guilt or innocence, but it does imply clarity of investigation.
Mental Health Bill [HL]
Monday 20th January 2025
(1 week, 5 days ago)
Lords ChamberRead Full debate Mental Health Bill [HL] 2024-26 View all Mental Health Bill [HL] 2024-26 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: HL Bill 47-II(a) Amendments for Committee (Supplementary to the Second Marshalled List) - (17 Jan 2025)
Earl Howe
Member’s explanatory statement
This probing amendment seeks to clarify the Government’s intended definition of “specified risk factors for detention” under Part 2 of the 1983 Act.
Earl Howe (Con)
My Lords, in moving Amendment 23 I shall speak also to the other amendments in this group, Amendments 139 and 141. These amendments, although they may not look it, are all of a piece, because they bear upon the fulcrum for any decision to detain a patient under the Mental Health Act, which is the concept of “serious harm” and what we mean by it. My noble friend Lord Kamall’s Amendment 141 offers such a definition, but we have tabled the amendment more as an Aunt Sally than anything else, because what matters is how we want the phrase to be interpreted in real-life situations by clinicians and others on the ground.
The concept of serious harm as a determining factor for detention is introduced by Clause 5. Clause 5(2)(b) replaces Section 2(2)(b) of the Act, which refers instead to detention in the interests of a person’s own health or safety, or with a view to the protection of other persons. The new wording is undoubtedly tighter than the old wording and, on that account, it is to be welcomed. However, it is not, as far as I can see, fleshed out by any definition. That could, of course, be deliberate, because, in the end, a decision to detain someone will always be a matter of clinical judgment. Such judgments, though, ought surely to rest on established understandings. Serious harm, as applied to the health or safety of the patient themselves, may be a relatively straightforward clinical judgment to make in many, if not most, circumstances. But what about serious harm as applied to the health or safety of another individual? Do we mean just physical harm or are we talking also about psychological harm? If so, of what kind and to what degree? Detaining someone on the grounds that serious psychological harm may be caused to another person raises all sorts of issues that fall outside a standard clinical judgment about the health and/or safety of a prospective in-patient.
The threshold of serious harm being caused, or at risk of being caused, is of huge significance for different types of patients. One of the really good things that this Bill seeks to do is to keep individuals with autism or a learning disability out of a mental health unit, unless they present with other behavioural symptoms that are treatable. That is because we recognise that not only is there no point in detaining such individuals when they display no treatable symptoms, it is also positively harmful to them to do so. In the same way, I think it is accepted that to detain a child or a young person forcibly in a mental health unit is a very big decision indeed, because what is meant to constitute a therapeutic environment is all too often no such thing. On the contrary, a mental health ward or even an A&E department can often seem both alien and frightening to a young patient, in a way that can exacerbate their acute disturbance of mind.
Nobody wants to see people detained forcibly in a mental health unit unless it is essential and right, but so often the choice is a binary one: to detain in hospital or not to detain in hospital. How much better it would be if, in particularly sensitive cases, there were another option, a place of safety and comfort close by in the community.
That is why I tabled Amendment 139. We know that community-based services can be a significantly positive alternative to treatment in mental health hospitals and secure units. We need to look at affordable ways of creating more, especially for those with autism and learning disabilities and for children where the alternative may indeed be forcible detention under the Mental Health Act.
The King’s Fund reported in July 2024 that
“community health services have about 200,000 patient contacts”
every day. Anxious Minds argues that community-based mental health services provide three key benefits:
“Geographical convenience of mental health facilities”,
the relative affordability of such services and, importantly, culturally sensitive approaches to care
“that appeal to diverse populations”.
Baroness Murphy (CB)
My Lords, as the noble Earl, Lord Howe, has mentioned, we will be talking about risk factors in the next group but one, and I will not go into the statistics and predictions at this point.
As has been pointed out, Clause 4 implies that specific risk factors for detention under Part II are readily identifiable and assessed, but as we will see, predicting episodes of violent behaviour or self-harm is peculiarly difficult to do. The clause suggests that it is not clinicians who will be doing these risk assessments but that the Secretary of State will somehow have some expertise from ICBs in how to do this. Apart from the rather obvious wisdom that the best predictor of future behaviour is past behaviour, I am not sure how these regulations can be drawn up.
I am anxious about the common prejudices around, for example, black patients of African Caribbean descent living in London, who have a higher risk of being detained under Part II than white patients, or Asians of an Indian subcontinent background. Who will draw up this list to say which of these items is going to lead to the risk of detention under Part II?
There have always been opportunities for the Secretary of State to intervene in the detention of patients under Part III of the Act, and some Secretaries of State have been more risk averse than others. I suspect that under this clause we will find some Secretaries of State taking a more hard-line view about who should and should not be detained. That gives cause for enormous anxiety, so I would like to know how the Government intend to devise these regulations to document specific risk factors.
Baroness Tyler of Enfield (LD)
My Lords, this is an important set of amendments, and, as the noble Earl, Lord Howe, said, they are central to decisions about whether to detain people under the Act.
I agree that the definition of “serious harm” is important, and it would be helpful to hear from the Minister what the Government are thinking there, how it will be applied, and how any thresholds will be established.
I endorse what the noble Earl had to say about children and young people, what a huge decision it is to detain someone under 18 in hospital against their will, and how hard we need to work to avoid that, whenever that is safe for themselves and other people.
Finally, and very much linked to that, I strongly support Amendment 139 on the availability of community-based services, which we have already talked about and which we will turn to in subsequent groupings. It is a very good amendment, particularly the provision which states:
“The Secretary of State must publish a report to assess whether there should be more community-based services for community patients in order to prevent”—
I see this as a key preventive measure—
“detention under the Mental Health Act 1983”.
My one point is that the amendment talks about publishing that within two years of the day on which this Act is passed. I personally think that in an ideal world we might see a report a bit earlier than that. However, as I say, Amendment 139 certainly has my full support.
Baroness Parminter (LD)
I am sorry that I did not jump up in time before my Front Bench spoke.
I just wanted to add my voice to support Amendment 139 in the name of the noble Earl, Lord Howe, and the report on community-based services. It is really timely and we need it. The case was made very carefully and well by others, so I will not expand much other than to say that an extensive report was done in November by the leading charity, Beat, which looked at the case for more intensive community care and daycare for people with eating disorders in order to avoid—the very point that the noble Earl, Lord Howe, made—ending up getting to such a point of severity that they need to go into mental health facilities and be detained, which indeed happened to my daughter, as I made clear at Second Reading.
The case has been well made that a report should be made. I agree with my noble friend Lady Tyler that two years seems quite a long time off, particularly as recent work has been done, particularly in the field of eating disorders, to show that you can both reduce the number of patients and reduce the cost if you make the investment up front in community services.
Baroness Watkins of Tavistock (CB)
My Lords, as an ex-community mental health nurse, I wish in particular to support Amendment 139. I am convinced that we need appropriate ratios of such staff to deliver preventive services in the community as well as ongoing support. We need to remember that the NHS rests in the future on preventing rather than treating, and this is an important amendment that acknowledges that.
Baroness Buscombe (Con)
My Lords, I want to add to what the noble Baroness just said. Amendment 139 goes to the heart of the Bill in terms of changing the culture and the way that we treat people. The Bill will become a piece of law that is practical only if we can honestly put hand on heart and say that we will substantially increase community-based services. Without that, it will not deliver that which we all believe will be the minimum to improve people’s lives.
Baroness Berridge (Con)
My Lords, on the amendment outlining the definition of “serious harm”, two situations were raised with us on the Joint Committee. One was that the change in the criteria is the main tool that will help with racial inequalities; I would be grateful if the Minister could outline how she envisages that will work in practice. The second point was about the period during which such serious harm has to be exhibited. We heard numerous times about people with psychosis, many of whom—I think it was over 70%—do not realise that they are getting ill when they are presenting. How poorly do they have to get? Sometimes the intervention might need to be sooner than in the definition we understood of “serious harm”, which was slightly different from that which the independent review had, which I think was of “significant harm”. If the Minister could address those two points, that would be very helpful.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, I thank noble Lords for their contributions to this important debate in which a number of key issues have been raised.
Amendment 23, tabled by the noble Earl, Lord Howe, and supported by the noble Lord, Lord Kamall, relates to new Section 125D, regarding registers of people with a learning disability and autistic people who are at risk of detention. The amendment would remove new Section 125D(5), which defines
“specified risk factors for detention”.
I heard the noble Earl, Lord Howe, refer to this as an Aunt Sally amendment—I politely have “a probing amendment” here but I hope that we are in the same area—that is intended to clarify the definition of
“specified risk factors for detention under Part 2 of this Act”.
Earl Howe (Con)
My Lords, I thank all noble Lords who have taken part in the debate on this group of amendments. As I trust was clear from my opening speech, all three are intended as probing amendments designed to tease out some key definitions. It was actually Amendment 141, regarding the definition, that I described as an Aunt Sally.
I was particularly grateful for noble Lords’ support for Amendment 139 and for the Minister’s helpful comments. There is very little doubt that, as I think is generally accepted, community services delivered in partnership by local charities and civil society both reduce the cost to the state and carry the benefits I articulated earlier. Without implying any criticism of the NHS, those sorts of organisations will of course know their own communities better than an NHS hospital will.
I am grateful to the Minister for what she was able to say about the definition of “serious harm”. The Explanatory Notes state that a test of serious harm has been introduced
“to provide greater clarity as to the level of risk of harm that a person must present in order to be detained”.
They then state that further guidance on what constitutes serious harm will be set out in the code of practice. So far, so good, and it is welcome that that will be clarified in the code of practice, but one of the issues here is that that will come later. Serious harm is included as one of the two key tests for detention in Clause 5, so what is meant by serious harm will impact on all future decisions made within the scope of the legislation. Therefore, we need maximum clarity from the Government as we debate the Bill.
As regards the “specified risk factors”, I am again grateful to the Minister. I slightly worry that a person’s past history of admission to hospital could constitute a specific a priori risk factor for detention. There is a danger that that may turn into a directly determining factor for detention, rather than a factor to be taken into account in assessing an individual set of circumstances.
As regards drug and alcohol misuse, we need to be careful not to encourage a circumvention of the Mental Health Act, which explicitly excludes drug and alcohol addiction as grounds for detention.
I am once again grateful for the support that noble Lords were able to give to my amendments. I beg leave to withdraw Amendment 23.
Lord Scriven
“125FA Report: sufficient commissioning services for people with autism or learning disabilities(1) Within four months of the day on which the Mental Health Act 2025 is passed, the Secretary of State must lay before Parliament a plan to allocate sufficient resources for commissioning services regarding the treatment and detention of autistic people and people with learning disabilities to ensure operability of provisions in this Act.(2) The plan must include—(a) revised assumptions of the number of autistic people and people with learning disabilities who may require detention under this Act;(b) the actions that the Secretary of State will take to ensure community services are available to meet demand after the 28-day detention period;(c) plans for data collection to support commissioning sufficient services;(d) plans to allocate appropriate resource to ensure operability of services, including, but not limited to, financial resource;(e) plans to ensure that responsible bodies and individuals receive the necessary training to carry out support, diagnostic, and treatment plans.”Member's explanatory statement
This amendment requires the Secretary of State to present a plan within four months to ensure sufficient services, resources, data, and training are in place to support autistic people and those with learning disabilities under the Act.
Lord Scriven (LD)
This group of amendments has to do with learning disabilities and autism, and the implementation of the Government’s recommendations, particularly on the change in detention criteria. My Amendment 33 is probing; I shall come to its details shortly. The Committee needs to look into this subject, because many times before in government policy we have seen a good aim and good intentions of moving care into the community, but all too often the facilities have not been there, and people have ended up in crisis.
I tabled Amendment 33 to probe the Government’s staged approach to ensure that community facilities are in place before the change in detention happens, and to understand their timing. On page 72 of the impact assessment, the suggestion is that the change will not happen until the community facilities are in place. That is good, but that could be five, 10 or 15 years away, so the Committee needs to understand the Government’s approach to timing.
Amendment 34, tabled by my noble friend Lady Barker, and the amendment tabled by the noble Earl, Lord Howe, cover mandatory training for medical staff and others associated with looking after people with learning disabilities and autism, to detect the signs, so that people are not missed and put into detention.
My Amendment 33 would create an obligation for the Government to lay a costed plan for sufficient services before Parliament within four months of the passage of the Bill. The four-month period is important, because we really need to understand the Government’s intentions on timing. The change in detention criteria for autistic people and people with learning disabilities is a vital change in the Bill, to ensure that people are not inappropriately detained but are supported in the community instead.
As I have said, success depends on there being sufficient services in each area across the country to meet the needs of autistic people and people with learning disabilities. Based on the impact assessment, we know that the Government do not plan to enact those, so it is important that when the Minister replies, she lets the Committee know exactly what the timing is and what the Government’s assumed plans are.
In the equality impact assessment, there are dates for both funding and implementation, which seem to be at the same time. As a former NHS manager, I can say that people cannot start a service involving such a change and receive the funding in the same year. There has to be upfront funding to enable people to plan the services over time. Otherwise, the services are not there, and staff run round trying to get services when people are in distress. It is important to understand that.
Additionally, as the NHS long-term plan target to reduce the number of detentions of autistic people and people with learning disabilities has been missed, there are no active targets to get people out of hospitals. My amendment tries to put in targets to hold the Government and the services to account on ensuring that people are not inappropriately detained.
It is important to have a comprehensive action plan, which is what my amendment seeks to do, and to find out exactly how the Government intend to build and fund those community services moving forward. Additionally, this must include new targets to reduce the number of detentions of autistic people and people with learning disabilities. The timelines for building this support will also be crucial if the Government are to meet the expected 2026-27 commencement date for the new detention criteria for autistic people and people with learning disabilities.
I hope that the Minister will fully brief the Committee so we can make an informed decision about not just the thinking of the Government but the detailed implementation around community services with the change of criteria. I look forward to hearing noble Lords speak to their amendments on the provision of training and the appropriateness of medical practitioners’ expert knowledge of learning disabilities and autism. I beg to move.
Baroness Barker (LD)
My Lords, I shall speak to my Amendment 34. As I do so, I extend my condolences to the noble Baroness, Lady Hollins. We miss her very much today. She was extremely helpful to me only a few days ago when we were discussing the subject of this amendment, so I hope I do her a lot of justice with this.
We have heard time and time again that people with learning disabilities and autism find themselves on the wrong end of diagnoses made by practitioners with the best of intent, quite often when people are at points of severe distress, that are inappropriate because the people making them have not perhaps had the degree of experience and knowledge of working with people with learning disabilities and autism as they would otherwise have done.
We started to discuss last week that, while there are mental disorders for which detention in the sorts of facilities that we fund in acute hospitals in the NHS is right and appropriate, there are also some people for whom detention in those circumstances is absolutely not; it is an aggravating factor. Therefore, in my amendment I am seeking to address that issue: not just the competence of the people making decisions about detention and treatment but also the confidence with which they, as professionals, can approach the jobs that they are increasingly being required to do. Knowledge and understanding of learning disability and autism is expanding all the time. We now have a greater number of adults than ever before who, at stages in later life, are being diagnosed as being autistic, and I am quite sure that quite a number of those people have been subject to misdiagnosis.
The particular thing that I want to focus on is training for people who are responsible for detention and high levels of treatment. Noble Lords will be aware of the tragic case of Oliver McGowan, a young man with learning disabilities who was inappropriately treated and died. There has been an amazing campaign by his mother to ensure that that does not happen to other people by making sure that anybody who is involved in the provision of mental health services has undergone appropriate training and understands learning disabilities and autism.
My understanding from Oliver’s mother is that there are three tiers of training. Tier 1 is a level of training which is required for all people who work generally with people with learning disabilities and autism. They need to have this general level of awareness. Tier 2 is for health and social care staff and others with responsibility for providing care and support for a person or people with learning disabilities or autistic people but who would seek support from others in a complex management and decision-making process. They would be part of a team referring up to others. Tier 3 is specialist training for professionals who have a high degree of autonomy and are able to provide care in very complex situations, which might include people with learning disabilities and autism.
The training appears to be sequential. You have to have completed tier 1 training in order to go on to tier 2 and then tier 3. Tier 1 is an e-training module which takes about half a day. As far as I understand it, about 1.5 million people have done that. That is a good thing: we are getting to a greater basic understanding of learning disability and autism by many people across the NHS going about doing their jobs. Tier 2 is a one-day intensive training programme, and that has not gone so well. There have been problems with its implementation, and it is not clear how many people have undergone that training. There are also some quite considerable questions about the quality and scope of that training.
Tier 3 is not part of the Oliver McGowan programme, although it is the most relevant to this Bill. As of December 2024, the Department of Health website makes absolutely no mention of tier 3 training at all. Can the Minister tell us where the development of that training is up to, and who is responsible for ensuring that the content of it is suitable? Is it sufficiently developed for people who are having to make very difficult decisions, particularly around detention of people who are quite often in a state of disturbance at the point at which that decision is taken? If we do not follow up on this tier 3 training, then we are going to carry on in the situation where we are now, where we know that people are being wrongly diagnosed by people who, perhaps, should not be expected entirely to understand them because their professional training up to this point has largely not included such people.
The noble Baroness, Lady Murphy, and I bow to her superior knowledge, very much made the case to us last week that we are talking about different types of mental disorders and very different specialisms across the mental health services. I am therefore asking that anybody who is in a position of making the decision to detain—and let us remember that people are making decisions to detain not just under the mental health legislation but also, at times, under the mental capacity legislation—should be appropriately trained. That is why I put down my amendment which, I admit, is not perfect, but I hope that the Minister might take some of my point and my intent and that we might take this forward together.
Baroness Browning (Con)
My Lords, I shall speak to my Amendment 42A in this group, which follows on from the two previous amendments from the noble Lord, Lord Scriven, and the noble Baroness, Lady Barker, particularly the details that the noble Baroness has gone into about the need for training and expertise for people who are dealing across the piece with those with autism and learning disability and, importantly, when those clinicians take the decision to admit somebody. As we know, one of the problems that is facing us and why it is so important that these issues have come forward in this particular Bill is because there have been so many inappropriate admissions where people have been detained for so long that it has become a scandal.
Lord Beamish (Lab)
My Lords, I will speak to Amendment 33 in the name of the noble Lord, Lord Scriven. If this Bill is a success, we shall, I hope, see fewer people with autism and learning difficulties detained under the Mental Health Act. However, the noble Lord’s amendment goes to the heart of the problem of resources. The current system is broken. It is a market system, which ends up with a lot of people finding themselves detained in facilities far from home, and getting out of that system can be very difficult.
The collection of data will be important: first, to find out how many people are being detained. Having spent 23 years in the other place and having been a passionate advocate for mental health, I always found that data is one thing that is never really kept. It is kept between the Department of Health and various other healthcare providers. Getting that visibility for the numbers we are talking about will be very important.
We need to be honest that, in the entire mental health debate, people with autism and learning disabilities have been overlooked. To get this right, having proper community-based facilities will be very important, but it will be expensive. The market model we have at the moment means that lots of private companies provide care at very high cost, and commissioners tend to have to commission only from certain providers. This leads to a shortage of supply and prices going up. The Minister needs to spell this out.
I understand what the noble Lord said in moving the amendment, but it is important to have visibility of not only the numbers but where the community facilities are going to be. New Clause 125FA(2)(b) in the amendment says the Secretary of State should ensure that community services are available to meet demand after 28 days. If you speak to any commissioner at the moment, they will tell you that that is completely unrealistic. I accept that it was put in the amendment for debate, but that is an aim we should be trying to get to in supporting people in the community. I have seen sad cases of people being stuck in the system. With the best will in the world, and I think there is cross-party support for this, we should not have people with learning disabilities and autism stuck in the system for as long as they are, with no way of getting out. I accept that the Bill aims to give a voice to those individuals, but without the resources to match, they will still go round the merry-go-round of different funders.
Another important issue that we need to highlight is the lack of support staff in the community for dealing with people with learning difficulties and autism. That is not seen as a priority at college. We need to put more emphasis on making it an attractive career and on the fact that it is vitally needed and will make a real difference to the individuals concerned. Training is important, but so is getting people into the service in the first place. I accept that the noble Lord is not going to press the amendment, but it goes to the heart of most of the matters in the Bill. We are deluding ourselves if we think the good and well-intentioned things in the Bill will be delivered without the resources to do so; they will not. The one without the other will lead to people still being detained when, in a modern society like ours, they really should not be.
Baroness Murphy (CB)
My Lords, I give my strong support to the noble Lord, Lord Scriven, asking for a road map, which I think is the political phrase we use now, to get to where we want to be. I remind him that, back when the then Government came in in 1987, we had a documented timetable for closing the learning disabilities hospitals but that never happened; it went too slowly. So, we have left people stranded in various independent sector and NHS facilities, partly, to be honest, because the Department of Health took its eye off the ball as to what was happening to people in long-stay care and just stopped looking. So I agree that we need some kind of timetable; otherwise, the Bill becomes simple aspirations, as we have already said.
Unfortunately, it is not just autism and learning disabilities that require special training. In a lot of areas of mental disorder, people get inadequate training in subspecialties when they are studying the general psychiatric stuff. Psychiatric nurses do not get enough, either. I agree that there are issues here that require a special target, but at the moment they do not get it, so I support that as well.
On the experience of the noble Baroness, Lady Browning, of course it is true that there are an awful lot of bad psychiatrists around. There are bad physicians and bad surgeons—not the noble Lord, Lord Kakkar, before he punches me on the chin. We should not say “bad”; I would say “not the best”. A friend of mine was visited by a community psychiatrist in old age psychiatry about a month ago. I asked his partner how it went, and he said, “Well, he was in and out in 15 minutes. He’d got 10 assessments he was going to do in people’s homes around south Norfolk in that time”. That was a totally inadequate amount of time to get a history from relatives, to get an understanding of what was going on in the home situation and to understand the problems this person was experiencing. I was shocked, but I was told not to be because it happens all the time that there is an inadequate length of time for people’s assessment.
It is hardly surprising that diagnoses are wrong and that people end up with the wrong prescriptions. It is deeply regrettable, but this will happen for as long as community services are underresourced. As we have heard from all around the Chamber, you can put as much in place as you like, but if it is underfunded, has the wrong facilities or is too far away from where people live, it just will not happen. We need a road map, and we need to know when these facilities will be made available, because the rest of it cannot happen until they are.
Baroness Bennett of Manor Castle (GP)
My Lords, I will speak to my Amendment 152. We have already had a rich debate, concentrated on certain areas. This amendment deals with a somewhat different area, which is why I wanted to include it at the end. We have talked quite a bit about training and research and the link between the two. The noble Lord, Lord Scriven, said in introducing this group that it was all about autism and learning difficulties, but this amendment also covers mental health, for the interests of clarity.
This is a probing amendment, but there is an argument for doing what it calls for, which is having a report to Parliament, two years after the Bill is passed and then every three years thereafter, about the provision for and progress in research, and the transfer of research findings, in mental health and autism and learning difficulties. This would enable Parliament to keep a check on how much resource is being put into this area and, crucially, how much knowledge is transferred into practice. It would also be a really useful tool for informing Parliament about what is an extremely fast-changing area.
It is worth noting that mental health and disabilities are areas in which research is not just redefining our understanding but often entirely demolishing old models and forcing a restart from the basics. We are also seeing a change in approach, in which I am very pleased to say that there is an increased focus on ensuring that experts by experience can guide and have input into research directions in a way that certainly was not true in the 20th century.
I note, for example, an interesting study from the University of Stirling last year, which spoke to people in Scotland—though I have no doubt this applies more broadly. It looked at how research in autism currently tends to be directed towards biological studies and a search for treatments and cures, but autistic people said that they would prefer a focus on a good quality of life, and that they should have a real say in the research directions. They were concerned that continuing even now are ableism, objectification, and other othering approaches in research directions. I spoke on the previous day in Committee about the failure to apply the social model of disability to learning difficulties and autism. That is very much the case. I hope that that will change, which would change what we should be researching and how we should be training people.
Moving to perhaps more comfortable ground for many people, I note that there is a replication crisis across many areas of research. That is particularly true in the mental health space, where, unsurprisingly, there has been a recent dawning that conducting a great deal of research on US college students does not necessarily produce findings that can be replicated all around the world in all sorts of different research conditions. For example, with Alzheimer’s disease, are amyloid plaques a cause, a symptom or simply correlated? I have no idea, and I doubt that anyone can say, with their hand on their heart, that they know either. This an area in which the continuous failure of medical trials has shown our lack of knowledge.
Baroness Tyler of Enfield (LD)
My Lords, I want briefly to make a couple of comments on this important group. As everyone has acknowledged, an absolutely vital change to the Bill is that, in the future, people with learning disabilities and autism will not be detained by the Bill and their needs are to be met in the community. I am sure we can all agree on and gather around that.
The noble Lord, Lord Beamish, made the point that, far too often in the past, people with learning disabilities and autism have been overlooked. I see the Bill as a real opportunity to do something substantive about that. That is why I note some of the amendments we have heard about in this group—certainly those in the names of my noble friends Lord Scriven and Lady Barker, and others—about the importance of having properly trained staff with up-to-date knowledge and expertise, as the noble Baroness, Lady Bennett, has just mentioned.
For any of this to happen, it is important that there is a proper plan, that is costed; the resources need to be available, and properly trained staff with up-to-date expertise need to be available in the community. To ensure that there is some sort of accountability around all this, I reiterate the question that my noble friend Lord Scriven asked the Minister: when will we see new targets—we have not got any at the moment—to reduce the number of detentions of people with learning disabilities and autism? It would be helpful to know that those targets will be put in place and that there is some way of monitoring the progress on all the important things we have been talking about in this group.
Lord Patel (CB)
I agree with what has been said: we need a definitive plan for how things will work out. We cannot rely on it being in five or 10 years because, as the noble Baroness, Lady Murphy, said, it then just becomes an ambition rather than a target to achieve.
I support the amendment of the noble Baroness, Lady Browning, which strongly asks that the people who look after children with autism and learning disabilities are properly assessed by properly trained and accredited people. We know that, currently, children are ending up in detention inappropriately because they are assessed to have a psychiatric condition such as schizophrenia—as the noble Baroness, Lady Browning, said—when, although they might have some psychiatric sub-condition, they fundamentally have autism or learning disability problems.
I am sorry that the noble Lord, Lord Adebowale, is not here to speak to his Amendment 150, which asks quite powerfully for a clear plan to be laid out, with resources tied to it, to achieve the ambitions there are in the Bill. I would have supported his amendment probing the Minister as to how resources will be allocated to achieve the ambitions for those targets to be met.
Lord Kakkar (CB)
My Lords, I support Amendment 42A in the name of the noble Baroness, Lady Browning, and I ask the Minister what justification there could be for refuting the amendment. It seems entirely appropriate, and indeed essential, that in taking such an important, far-reaching decision, one of the two registered medical practitioners who is responsible for that decision, taken at one point in the management of the natural history of disease in that individual, has the specialist skills and training to be able to make an appropriate assessment, one that will affect interventions on all future occasions for that individual.
I hope that, in addition to accepting this important principle, the noble Baroness might outline how His Majesty’s Government will go about ensuring that the development of such medical practitioners and their training is adequately resourced to ensure that, in future, as a result of the Bill being enacted, what we have seen in the past, regrettably on repeated occasions, does not remain the norm for managing patients with autism and learning disabilities.
Earl Howe (Con)
My Lords, I shall be very brief, because other noble Lords have already eloquently articulated the arguments that are almost self-evident about the importance of services for people with autism or a learning disability and, in particular, the importance of training all staff who may find themselves working in those fields. I agree very much with the remarks of my noble friend Lady Browning and the noble Lord, Lord Scriven, and I was particularly interested in the research mentioned by the noble Baroness, Lady Bennett of Manor Castle, which brings us into a whole new dimension, I think, in this debate.
The need to train all healthcare staff, no matter what role they perform or which part of the health service they serve in, should surely be taken as read. This should be training both in the initial identification of those with autism or a learning disability and in the skills needed to handle such individuals with the necessary sensitivity and insight. I was interested in what the noble Baroness, Lady Barker, had to say about that. The behaviour of a person who is on the autistic spectrum can be baffling to anyone who has had no experience of it, and because of that it can be open to misinterpretation. A situation of that kind carries dangers, which is why it is so necessary for healthcare staff to know how to react in a way that will make the situation better and not worse.
This is not the first time that we have debated this important topic. I believe we may be told by the Minister that mandatory training in these areas is already provided for in Section 20 of the Health and Social Care Act 2008. The provision reads:
“Regulations under this section must require service providers to ensure that each person working for the purpose of the regulated activities carried on by them receives training on learning disability and autism which is appropriate to the person’s role”.
That broad provision was inserted into the 2008 Act thanks to an amendment which your Lordships approved three years ago, during our debates on the Health and Care Act 2022.
So, a provision on training is already enshrined in law; the problem is that we have no way of knowing the extent to which it is being implemented in practice. Hence, Amendment 145 would require the Secretary of State to publish a review on mandatory training for all persons who treat patients with learning disabilities and autism under the 1983 Act and consult as necessary to determine the extent to which health service staff are actually in receipt of such training. I see this amendment as perhaps a logical partner to Amendment 152 in the name of the noble Baroness, Lady Bennett, and indeed, in his absence, to the amendment of the noble Lord, Lord Adebowale.
While the vast majority of people who provide care to people with learning disabilities and autism do so with compassion and professionalism, we have seen a number of failings in care for people with those conditions. At the same time, detention will continue to be necessary in some cases where a patient with autism or a learning disability is suffering from a separate mental health condition. In all those cases, regardless of the context in which a person presents, we need to have confidence that the people providing care have the training they need to deliver that care sensitively, and above all, capably. I would venture to say that the people who need to have most confidence in the system apart from the person receiving the care are the parents or nearest relatives of that person. Hence, I believe we need more transparency on how well the system is working than we have currently.
Incidentally, one of the things that could come out of a review of training is an opportunity to look at the current processes for whistleblowing. An important aspect of improving standards of care is to have a system of accountability that includes listening to everyone in the sector, from the most senior staff to the most junior. No one should be afraid to speak up when they see something going on that does not look right, and I should be very grateful to hear what the Minister has to say on this whole theme and on the other important issues that noble Lords have raised.
Baroness Merron (Lab)
My Lords, I express my gratitude to noble Lords, not just for their amendments but for the way in which this debate has been conducted. I appreciate much of what lies behind the contributions and amendments today.
I first turn to Amendment 33, tabled by the noble Lord, Lord Scriven, and supported by the noble Baroness, Lady Hollins, and also Amendment 150 in the name of the noble Lord, Lord Adebowale. All of these were spoken to throughout this group, including by the noble Baronesses, Lady Tyler and Lady Murphy. I noticed that Amendment 150 was particularly referred to by the noble Lord, Lord Patel, and the noble Earl, Lord Howe.
On the matter of data collection, I absolutely share my noble friend Lord Beamish’s view on its importance, the need for the visibility of data and the need to find out what is behind detention. However, I can give the reassurance that the data and statistics that were referred to are being collected and published. They will continue to be monitored and published monthly in the assuring transformation statistics for learning disability and autistic people, and I hope that will be helpful to my noble friend.
The amendments I am referring to, which the noble Lord, Lord Scriven, introduced, require the Secretary of State to publish plans within a specified timeframe, outlining the Government’s plan to allocate sufficient resources for the commissioning of services for the detention and treatment of autistic people and people with a learning disability, as well as costed plans which show how integrated care boards and local authorities will ensure provision of adequate community services for these groups.
Baroness Barker (LD)
This is a key point for a lot of the amendments that noble Lords have asked about. Can the Minister write to all noble Lords with more detail of the training programme—its content, the timetable, who is going to be responsible for making sure that it is implemented and reviewed? Will she specifically deal, in that letter, with my question about whether tier 3 training is included?
Baroness Merron (Lab)
I would be very pleased to write to noble Lords, as the noble Baroness suggests.
Amendment 42A, in the name of the noble Baroness, Lady Browning, which the noble Lord, Lord Kakkar, also spoke to, relates to appropriate expertise in learning disability and autism for medical practitioners with responsibility for recommending admission for treatment. We strongly agree with the principle of this amendment. The current code of practice sets out that, where a patient is known to belong to a group for which particular expertise is desirable, at least one of the professionals involved in their assessment should have expertise in working with people from that group wherever possible. The code also makes clear that consideration should be given to any disability the person has in order that the assessment has regard to that in the way that it is carried out.
The noble Baroness, Lady Browning, asked further about how the Bill will make sure that professionals have the right skills and expertise. This whole area rightly comes up repeatedly when we debate.
I accept that it is crucial that those with a learning disability and autistic people are dealt with sensitively and professionally. It is crucial that clinicians are able to make distinctions between a learning disability or autism and any co-occurring mental health disorder—that point was made powerfully. It is a matter for clinical judgment to determine whether a person with a learning disability or an autistic person meets the criteria for detention under Part II, Section 3 due to a co-occurring psychiatric disorder. To assist clinicians in decision-making, we will update the code of practice to provide the guidance that will be necessary, and I hope that that will make a major change.
Baroness Browning (Con)
I am grateful to the Minister and very encouraged by her response. I want to flag up something else that I raised. Occasionally, at some point of crisis for undiagnosed adults, the question is asked: could this be autism? At that point, we need people who have a very good working knowledge for them to raise that question, because it can make a world of difference if they are right. It is not just about somebody who presents with a diagnosis; it is about those who are undiagnosed. I do not know the quantity, but my gut feeling is that there are quite a lot of adults out there who are still undiagnosed. I do not know how the Minister will accommodate that situation.
Baroness Merron (Lab)
The noble Baroness makes a good point. Indeed, not everybody has a diagnosis. I suggest that, when we look at provisions, we should make clear—through the appropriate means and not in primary legislation—how the practice should take account of the point that she made very well. I will be extremely mindful of that.
We believe that the code of practice is the most appropriate place to articulate the type of experience that might be required in this area, through a non-exhaustive list of practical examples, which would avoid the need to define in primary legislation exactly what constitutes sufficient experience. The reason for that is to allow flexibility on the particular needs and circumstances of the individual. As we update the code of practice, we will engage with expert stakeholders to improve practice and to reflect the new Act. The code will be laid before Parliament before its final publication. I thank the noble Baroness, Lady Murphy, for her comments in this area.
The number of long-term detentions was rightly raised by my noble friend Lord Beamish and the noble Baronesses, Lady Murphy and Lady Browning. The number of people with a learning disability and autistic people in mental health hospitals is indeed unacceptable. Too many people are still being detained who could be supported in their communities with the right provision. Work is under way to address this. For example, NHS England has allocated £124 million of transformation funding for services, which includes funding to reduce reliance on mental health in-patient settings. Noble Lords can be reassured that I will take a particular personal interest in this area.
Lord Beamish (Lab)
On that point, I welcome what my noble friend the Minister has announced, but the real problem is about housing, including specialist housing in different areas for individuals leaving secure units. That is not universal throughout this country, as people leaving mental health units are then having to travel long distances. Surely we need local plans, and that money going in locally to provide the housing needed.
Baroness Merron (Lab)
My noble friend makes a good point about housing; we discussed it on day 1 in Committee. We are working with our ministerial colleagues who deal with housing on the need for the right kind of housing to be available. The point was well made and is taken.
Baroness Bennett of Manor Castle (GP)
I understand that the Minister may wish to write to me on this, but I wonder whether there is a real prioritisation of those experts by experience guiding that research, and what input there might be. If the Minister can write to me, that would be fine.
Baroness Merron (Lab)
I would be pleased to write to the noble Baroness.
As I set out in response to other noble Lords, I hope the Committee has heard how much I agree that the adequacy of training is a key issue. We are aware that developments in best practice in caring for people with a learning disability and autistic people need to be reflected throughout. As I set out, the Health and Care Act 2022 requires that staff be given the training appropriate to their role, and we expect that this should be reviewed in line with the up-to-date situation. The CQC assesses staff training as part of its regulatory function. For these reasons, I ask the noble Lord to withdraw his amendment.
Lord Scriven (LD)
My Lords, I thank noble Lords who have taken part in this useful and informative debate, and I thank the Minister for a thorough explanation of what happens. However, there does seem to be a disjoint between what is happening on the ground and what people in an office in Whitehall seem to think is happening. That is why noble Lords have discussed issues to do with data, training, a costed plan, research and development, and the implementation of people who at least have training and an expertise in diagnosis. Something just does not feel right. The Minister has explained what is happening, but without a fully costed plan up front, with targets, accountability and data ongoing, what will happen is what happens now. Things will be diverted and diluted, and we will not be able to hold the plan to account. For that reason, while I thank the Minister for the explanation she has given, I feel that we will return to this issue at a later stage to dig down and get that deliverable framework. In the meantime, I beg leave to withdraw my amendment.
Baroness Murphy
(b) there is a risk of serious harm to the health or safety of the patient or of another person;”Member's explanatory statement
This amendment and others in the name of Baroness Murphy remove from the criteria any mention of “likelihood” or “may be caused” and replace them with wording that allows a clinician to evaluate risk in the individual case and give evidence more straightforwardly and comprehensively without making predictions for individuals about risk.
Baroness Murphy (CB)
My Lords, in this group, we return to the issue of serious harm and risk. Clause 5, on the grounds for detention, implies that the risk factors for detention under Part 2 are identifiable and that risks are readily assessed. A number of clauses in the Bill are all about the same thing, which is why there are so many amendments in this group. They imply, again, that risks are quantifiable and predictable—if only.
Academic research has often stressed how difficult it is to predict episodes of violent behaviour in individuals, because they are rare. Risk assessments given as likelihoods are of limited use when the base rate for violence in a population, particularly serious violence, is low. The same is true, by the way, for suicide and suicidal thoughts.
It has been calculated, using the average of all the current tests and rating scales that have been carefully assessed in research studies, that if 5% of the patient population were in a high-risk category, the tests would correctly identify eight in 100 people who would go on to commit acts of violence, but misidentify as violent another 92 people. In fact, less than 1% of community patients will commit serious violence over the period of a year, which means the tests would correctly identify only three patients out of 100.
Homicides occur at a rate of one in 10,000 patients suffering from a psychosis per annum, which makes prediction more or less impossible. A number of factors are statistically associated with later violence at a group level. Even the most effective predictive combinations of variables constructed by statisticians perform poorly, except at group level. So making statements about individual risk based on the use of these tools is complex, and some would say unsafe and unethical.
Structured risk-assessment systems can be useful in routine clinical practice; indeed, most people use them in day-to-day team thinking about what these risks are. When employed by staff properly trained in their use, they are useful pointers. They perform better than unaided clinical judgment in predicting future violence, but again, at a group level. On an individual level, these checklists need to be part of a detailed understanding of a patient’s mental state, life circumstances and thinking, which is a major contributor to the prevention of harm. This is best achieved, as always, by well-trained professionals operating in a well-resourced environment where staff know well the patient’s history, response to treatment and life circumstances.
The wording of the Bill encourages pseudo exact probabilities and predictions of individual behaviour, which are not possible. This exerts pressure on psychiatrists, particularly at tribunals, to make predictions that may be seriously wrong. Unreasonable expectations of what can be predicted lead to defensive practice—to detaining people where it is not justified by the unreliable evidence. There are several places in the Bill where the impression is given that risks are reliable and predictable, but it is not so. As I say, the same problem arises with suicide and suicidal behaviours.
I ask the Government to look at whether the wording of these clauses is reasonable, given the evidence, and to substitute these certainties with something more flexible, indicating that a more rounded, holistic and comprehensive assessment is necessary. I beg to move.
Baroness Bennett of Manor Castle (GP)
My Lords, I rise to speak to Amendments 86 and 67, in my name, in this group. I put them in that order as Amendment 86 more naturally follows on from—
Baroness Murphy (CB)
I am awfully sorry, but I should have mentioned that I also have almost all the other amendments in this group. They cover the same question—it is just about the wording of these two phrases. Amendment 45, along with one other, is not mine, but most of the amendments are covered by those brief words.
Baroness Tyler of Enfield (LD)
My Lords, I think that I am speaking in the right group. Amendments 45 and 48 are in my name, and although they are in this group, they are of a rather different nature. They are about the framework and definition of “appropriate medical treatment”.
I will briefly outline the overall context and why I thought it important to bring these two amendments forward. I am particularly concerned that many in-patients in mental health hospitals, particularly autistic people and people with a learning difficulty, continue to face detention in hospital settings which can provide little or no therapeutic benefit. The environment of these hospital settings can be incredibly overstimulating and distressing. We continue to hear stories of restrictive practices, including physical, mechanical and even chemical constraint, as well as the use of solitary confinement.
Lord Kamall (Con)
My Lords, given that all those who have spoken to this group of amendments have been brief, I shall try to be brief. Once again, I thank the noble Baroness, Lady Murphy, for discussing with me in an exchange of emails over the weekend the intent behind the amendments in her name.
The noble Baroness, Lady Murphy, makes a reasonable point about clauses in the Bill that contain the phrase “likelihood of the harm” or “serious harm may be caused”, because it is assumed that such risks are quantifiable and predictable. I was struck by her observation that psychiatrists, psychiatric nurses and academics have warned about the difficulty of being able to predict episodes of violent behaviour in individuals because the base rate for violence, particularly serious violence, in the population is low. One of the things that we keep saying throughout this debate is that we need to see the evidence and the data, and that that should drive decisions that are being made. Given that, I am grateful to the noble Baroness for sharing the statistics, which I will not repeat but which reinforce the point that she wanted to make.
Considering those statistics, I am sympathetic to two specific points that the noble Baroness made. The first is that making statements about individual risk based on such statistics is complex and possibly unsafe, and, as the noble Baroness said, may be unethical. The second is that it may be helpful to use structured risk-assessment systems in routine clinical practice, if used by appropriately trained staff, to predict possible violence at a group level. However, given that many noble Lords have spoken about patient-centred care and the importance of understanding the individual and their sensory profile, surely we should be looking at patients as individuals, where the clinician better understands the individual patient’s mental state, relevant history and response to treatment given his or her life circumstances.
I will be interested in the Minister’s response to the amendments in the name of the noble Baroness, Lady Murphy, urging the Government to replace wording such as “likelihood of the harm” or “serious harm may be caused”. These terms are inexact and somewhat ambiguous and do not appear to be driven by evidence. Perhaps there are more appropriate terms for more holistic and comprehensive assessments.
Amendment 45, tabled by the noble Baroness, Lady Tyler, proposes that the definition of appropriate medical treatment includes the setting in which treatment takes place. This takes us back to a point made on the first day in Committee by the noble Baroness, Lady Barker, and just now by the noble Baroness, Lady Tyler, that for those with autism and learning disabilities, being held possibly in noisy, bright, busy settings full of people who may be strange to them, and where they may feel powerless and worry about what will happen next, is likely to affect their mental health and well-being. Therefore, surely it is important that we take account of the points made by the noble Baronesses, Lady Barker and Lady Tyler, particularly in Amendment 45.
On Amendment 48, it is really important that care is led by the level of therapeutic benefit. That should be based on evidence to drive those decisions. Given that, I look forward to the Minister’s response.
Baroness Merron (Lab)
My Lords, I am most grateful for the contributions that have been made and the amendments that have been tabled.
I turn first to Amendments 37A, 37C, 38A, 38B, 42B, 42D, 42E, 42G and 42H, all tabled by the noble Baroness, Lady Murphy, and spoken to by other noble Lords, including the noble Lord, Lord Kamall, regarding the new criteria. Let me say at the outset that the new criteria explicitly require decision-makers to consider the risk of serious harm and the likelihood of those harms occurring in order to justify detention. Clearly, the reason for this is to ensure that any risks to the public and the patient are consistently considered as part of the assessment process, and to protect patients from lengthy detention when these risks are unlikely to occur. I hope that this will be helpful for some of the debate that we have had.
The amendments tabled by the noble Baroness, Lady Murphy, seek to revise the proposed new risk criteria to remove any mention of risk that “may be caused” or the “likelihood” of the risk transpiring. The purpose appears to be to remove any prospective assessment from the detention decision and instead focus on the risk as it can be established at the time. The noble Baroness, in her introduction, asked about the reasonableness of the words in the provisions, and I understand that this is where the concerns lie. I should also thank the noble Lord, Lord Kamall, for his comments on evidence and data and their importance. In answer to the noble Baroness, I should say that the independent review found that the current criteria for detention are too vague and recommended that the Government should update the detention criteria to be more explicit about how serious the harm has to be and how likely it is to occur to justify detention. The intention of the revised detention criteria in the Bill is not to ask clinicians to make predictions but to clarify that they should consider whether a harm is likely to occur, based on their assessment and knowledge of the person—something that the noble Lord, Lord Kamall, focused on—rather than based on risks which may never occur.
Any consideration of risk arguably preserves the need to look at what might happen rather than what is happening or has happened in more concrete factual terms. We think that it is important that the detention criteria allow clinicians to detain based on the risks that they think are likely to happen, rather than just the risks that have already materialised. This enables them to act early to prevent harm to the patient or others. In line with the intention of the noble Baroness’s amendments, this should be based on personalised individual risk assessments and information about the patient’s history and personal circumstances—again, something that I know noble Lords are exercised by, which is about the individual approach to this.
We did engage again on the changes to the detention criteria last summer, in light of the recommendation on this issue by the pre-legislative scrutiny committee, and to assure ourselves that the detention criteria struck the right balance between allowing clinicians to continue to take early action when they are concerned about a patient’s or others’ safety and the independent review’s concerns that people could be detained on the basis of risks that might never occur.
Baroness Murphy (CB)
I thank the Minister for her response. I have to say that psychiatrists remain worried about this and the possibility that they will be expected to make decisions on risks which they are simply not capable of doing. But I would not want there to be a feeling around that we want to discourage people from taking action much earlier than they sometimes currently do, because, in my view, they often leave it too late before they admit somebody—we have seen a number of such cases recently. I reserve the right, perhaps, to come back with some alternative ideas, but I beg leave to withdraw my amendment.
Baroness May of Maidenhead
Member’s explanatory statement
This amendment and others in the name of Baroness May seek to introduce a new category of “authorised person” who can carry out detentions under the 1983 Act to offer better inter-agency response. The proposed amendments would remove the need for the presence of police at mental health incidents in the absence of any risk.
Baroness May of Maidenhead (Con)
My Lords, the amendments in this group standing in my name, Amendments 37B, 38C, 42C, 42F and 128B, are all intended to widen the definition of those who can attend a mental health incident and act to detain an individual in a variety of circumstances.
It is a pleasure to speak after a number of noble Lords who have a considerable wealth of experience on the issues in this Bill. I can claim no such breadth of experience, but the amendments I have tabled speak to one issue, which I have dealt with in the past: that of who can attend a mental health incident and particularly the attendance of the police at such incidents.
Back in 2010, it became clear to me, as I spoke to more and more police officers in my role as Home Secretary, that there was one issue that was at the forefront of their mind, and it was the problem they had in dealing with people at the point of mental health crisis. Their concern was understandable: they had no training in mental health, they were not professionals in this area, yet they were being called out to situations. They were being expected to determine whether someone was at the point of crisis or not, and what should happen to that individual; more often than not that meant taking that individual to a police cell as a place of safety. For the police officer, there was concern that they were being asked to deal with something for which they had no training or knowledge.
Of course, the police presence was often not good for the individual concerned. Inevitably, it meant they were not being given the healthcare support they needed at that point in time; but more than that, the very essence of a police presence—somebody in the uniform coming to deal with them—could actually exacerbate their mental health situation, and a police cell is not designed to improve somebody’s mental health. Finally, for the police force, of course, it meant that it was taking up resource which could have been used elsewhere, and which was, in many cases, inappropriate; often if somebody was in a police cell as a place of safety it meant that an officer had to sit outside the cell to ensure that they did not harm themselves.
The issue of the use of a police cell as a place of safety is dealt with in other parts of the Bill, but they do not deal with this wider question of the police resource that is being used. Even if the police are lucky enough to get somebody to a hospital, they still could have to have an officer in A&E sitting with the individual to make sure they do not harm themselves or cause harm to others. Indeed, the Metropolitan Police, in its evidence to the Joint Committee on the draft Bill, cited a case study where a patient was required to be guarded by the police in A&E to prevent them becoming a high-risk missing person, and eight Metropolitan Police officers had to attend that individual for over 29 hours. Police officers were worried about the job they were doing, the individual concerned was not being treated or dealt with in the way that was appropriate for their mental health needs, and police resource was used unnecessarily.
Over the years, I and others have tried to address this situation, initially with some success. But what often happens in government, as noble Lords and the Minister will find over time, is that an initial success is turned back because over time people revert to the previous behaviour or mode of operation. That is what we have seen in this case, and it came, of course, to the point where the Commissioner of the Metropolitan Police said that the force would not give an ultimatum and would not turn up to these mental health incidents.
As drafted, the Bill has the capacity to at least maintain, if not exacerbate, this problem, but the Government could accept amendments or amend it in a way that would improve the situation. I should say that, of course, if there is an immediate risk to life or serious injury, the police will always have a role to play; but they are clear that they want to see mental health repositioned as a health matter and not seen through the lens of crime and policing-related risk. This is the position that the National Police Chiefs’ Council took in its letter on the Bill to the current Secretary of State for Health, which said:
“The current position of the law arguably views mental health through the lens of crime and policing related risk, which raises a number of issues including disproportionality in the criminal justice system, discrimination, adverse outcomes for people suffering with poor mental health as well as increasing stigma attached to mental health”.
That concern that the focus and statutory footing of the police as the primary responder to incidents of mental health should be removed from the Bill is what has led to my amendments—it is what they are intended to deliver.
I see similarities between my amendments and Amendment 158 in the name of the noble Lord, Lord Davies of Brixton. If I may be so bold, I think we are both trying to achieve a situation where the expected response to someone in mental health crisis is not limited to police; in other words, “right care, right person”. My amendments are intended to widen the description of those who can attend mental health incidents beyond a constable, but they specify that a police officer—the holder of the position of constable under the Crown—can respond if there is a genuine need for a police presence.
Recognising that we do not want to see healthcare professionals put at risk, the amendments specify that the authorised person attending an individual should have been
“trained and equipped to carry out detentions”
and by carrying out that function should
“not be put at unnecessary risk”.
It is worth noting, perhaps at this point, that the College of Policing’s mental health snapshot 2019 found that almost 95% of calls that police attend that are flagged as a mental health response do not require a police response.
I referred to the reasons behind my amendments in relation to the police, but there is support among healthcare professionals for such changes. In the joint Home Office and Department of Health review of Section 135 and Section 136 powers, 68% of respondents to the survey, alongside the review, agreed that all or part of Section 135 and Section 136 powers should be extended so that healthcare professionals could use them provided they were not putting themselves at risk. Paramedics particularly supported the change, with 93.3% of paramedics agreeing and 61.1% strongly agreeing.
Beyond the interests of the police and healthcare professionals, of course, we must also remember the interests of the individual at that point of mental health crisis. They deserve the right response, the right care, the right person—and I do not believe that that is always a police officer. This Bill should reflect that and enable a wider range of authorised persons to attend mental health incidents. I beg to move.
Baroness Buscombe (Con)
My Lords, this is an area where I feel I have the possibility of a solution or part of a solution, while supporting very much what my noble friend has put forward in her amendment. My solution comes from knowledge that we have gained from the world of palliative care. It is a subject matter that we covered in detail on the joint scrutiny committee, because the whole issue of the police turning up to such an incident where somebody is absolutely in crisis can, in many instances, lead only to an increase in the fear and extraordinary pain that that person is feeling when they are in crisis. It is not the fault of the police; it is just the situation that they find themselves in.
Baroness Barker (LD)
My Lords, in speaking to my Amendment 49A, I thank the noble Baroness, Lady May, for her amendments. Those of us on the joint scrutiny committee spent a lot of time focusing on the fact that, in truth, a lot of what happens to people who are having mental health crises depends entirely on where they are, who is there and who somebody passing in the street and tries to help them thinks is the right person to call at a moment of emergency.
We are all in agreement that the police have for too long been the default answer to a problem but are not the right answer to a problem. The police know they are not the right answer to a problem—I say that as somebody who has lots of police officers in my family. A lot of people having a mental health crisis will end up in A&E just because the lights are on and that is where people go. We are still dealing with one of the problems the Wessely review touched upon, and that is lack of timely access to an accurate diagnosis.
My amendment, which I admit was suggested by practitioners in the field, tries to deal with the fact that we do not have an abundance of consultant psychiatrists who are there at the drop of a hat to make assessments. The amendment probes whether we might help things by opening up the eligibility to make diagnoses under Section 12 to people who are health professionals but not necessarily medical practitioners. Back in 2006-07, we had the massive argument about bringing in approved mental health professionals. That was a big battle and there was a lot of rearguard action on the part of consultant psychiatrists, who saw it as a downgrading. Approved mental health practitioners are now very much part of our mental health services and they are a good part of our mental health services.
The amendment is trying to open up the making of assessments, simply in order to speed up access to appropriate services. We all understand, and are talking about, the fact that, although we can see the effects of waiting lists and so on on physical health services, waiting lists and the lack of access to appropriate treatment in mental health services are much more hidden. People end up in limbo unless and until there is some kind of outrage, or, to go back to the noble Baroness’s point, until they do something sufficiently serious.
We ought to be freeing up the capacity of consultant psychiatrists in particular, because not only is demand growing but there are also particular areas of specialist demand—young people with eating disorders, for example. I frequently hear of worried parents being told that their children are not sufficiently ill to get treatment. They are not alone; there are other people in that same situation. My modest amendment is an attempt to open up and make better use of the skills we have within the NHS workforce.
Lord Davies of Brixton (Lab)
This is the first time I have spoken in Committee on the Bill, so I declare my interest as a member of the advisory panel of the Money and Mental Health Policy Institute. I shall speak to my Amendment 158, which, as the noble Baroness, Lady May of Maidenhead, said, covers essentially the same ground as hers, and they both aim at the same endpoint. Her elegant and compelling speech has left me in the position of just having to emphasise issues; the case made was compelling, and I hope the Committee will agree. In particular, I hope the Minister will be able to make some sort of positive response.
This proposal does not flow specifically from the independent review, but it is in the spirit of what was in that review. The background to the changing nature of mental health services is the significant material increase in the demand for mental health services over the past few years, and the growing number of people on the mental health waiting list or seeking community support.
This unmet need has consequences, which are felt by front-line medical staff. My amendment seeks to address that by giving additional powers to paramedics and appropriate mental health professionals. It would extend the reach of Section 136 of the Act, currently confined to constables—or police officers, as I say in my amendment. As previous speakers have said, that needs to be shared more widely.
The unfortunate reality of the current situation is that those detained under Section 136 get suboptimal care; we just do not have the resources available for them. There is inadequate provision of suites for Section 136 detention, and there are simply not enough clinicians. We all applaud and support the practice of “right care, right person”, but we must acknowledge that that only increases the demands on the service.
The result of all this is that, as we have heard, police officers are taken away from front-line policing duties for many hours. That is bad for everyone involved—for the police officers, for the health service, and particularly for the patients. At the same time, the skills of non-medical health service staff have increased. They are now moving towards the sort of training that equips them to handle such situations. Obviously, giving staff extra powers will not resolve the situation, but we can learn from experience abroad, especially in Australia and New Zealand, where a range of health service staff have a practice called emergency care orders, with the intention of providing greater dignity, removing the sense of criminalisation, and providing appropriate care.
As my noble friend the Minister said, what we are looking for is beneficial interventions at the earliest possible stage. A key element in achieving that aim is extending the powers under Section 136 to wider professions. That is not to say that there is no role for police officers—there will always be occasions when their intervention is required—but saying that the single source of entry to services of someone suffering an acute mental health problem is through the intervention of the police is just wrong.
There have always been concerns when the powers of medical staff are extended, but this will be an issue of training, guidance and codes of practice—clearly, those will have to be provided—so that the additional powers can be used effectively.
To conclude, I emphasise the point that the noble Baroness, Lady May, made in opening the debate. We have moved beyond the point when the powers in Section 136 were essentially about public order—which is, quite rightly, a role for the police. We must ensure that now, commitments under Section 136 are the first stage of a process of medical treatment, in which the unfortunate individual suffering an acute problem with their mental health must be considered first. This is not about public order; it is about appropriate healthcare, where a range of health service professionals can exercise their trained judgment to the benefit of the patient.
Baroness Watkins of Tavistock (CB)
My Lords, I support this group of amendments in principle, but I want to make two points. We talk about powers a great deal, but the therapeutic relationship is not about power; it is about collegiate working with patients and users of the service. I appreciate that there are times when we need to intervene when the patient does not want intervention, but we must be careful about the nomenclature as we redraw elements of the Bill.
In particular, I welcome the phrase that the noble Lord has just used, which is used so frequently in New Zealand and Australia: emergency care orders. We should think carefully about the fact that what we need is emergency assessment and care orders. People who work regularly with patients over a long period are often the best people to recognise a change in a patient’s behaviour earlier.
I fully support the idea that this should be extended beyond police constables, as the noble Baroness, Lady May, outlined, but I also recognise that there will be healthcare professionals, be they psychologists, nurses or social workers, who do not want to take this on. We must make certain that we do not lose some of our valuable team by making it compulsory to take on that extended responsibility.
Baroness Tyler of Enfield (LD)
I shall make a few points in response to the amendments that we have been discussing in this group. The noble Baroness, Lady May, made, very powerfully, an incredibly compelling case. The point she made about police officers sitting in A&E for many hours is so important. Not only is that a waste of police resources, it is often completely inappropriate for the person suffering from acute mental health problems. It can also be incredibly alarming for others in A&E. We all know that, sadly, far too many people are waiting for far too long in A&E, in the sort of environment that is in no way conducive to their overall health, physical or mental. That is my first point.
My second point relates to something that the noble Lord, Lord Davies, said. There will still sometimes be a role for police officers. I know from personal experience how much a police presence can be required when a person suffering a very acute mental health crisis is likely to harm both themselves and others. Those others can often be family members who are trying to support the person suffering from the crisis but are also pretty scared for their own safety. It is important that we are talking about widening the range of people who can be that primary responder, but we are not saying that it should never be the police.
I agree that if we have a wider primary responder, that individual must be prepared to do it, happy to do it and appropriately trained. We heard a lot in earlier groups about the importance of good training. I was particularly taken with the statistic that the noble Baroness, Lady May, raised about the views of paramedics and how many of them support this, because they are the people right at the sharp end. I cannot quite remember the number who support it, but it was very large, and so I think it is something that we should take seriously.
Finally, I want to lend my support to Amendment 49A in the name of my noble friend Lady Barker. Speeding up access to appropriate services is important, as is making the best use of the workforce that we have. For those two reasons, the amendment that my noble friend put forward is important.
Lord Meston (CB)
My Lords, I hesitate to interrupt, but I want to make much the same point that the noble Baroness has made based on my experience of a trip to A&E last year. I mentioned it anecdotally at Second Reading. There was a very disturbed person in A&E when I was having to wait there for some three hours. The hospital staff were struggling to contain the person in one room, as he kept leaving. He was not violent, but he was obviously distracting the hospital staff and worrying the other people present, who included children. As soon as anybody asked the staff what they were going to do, they said that they had to wait for the police. I have no doubt that the whole episode that I witnessed was prolonged by the need to wait for the police. Clearly, if this amendment or something like it is approved, it will widen the range of those who could be called upon to deal with such a crisis.
Earl Howe (Con)
My Lords, there is little for me to do following the persuasive speech of my noble friend Lady May, other than to say how much I support her in putting forward her amendments. I hope that the Minister will approach the proposals my noble friend has made in a receptive and constructive way.
I was struck by the case put forward by my noble friend Lady Buscombe about how technology could assist in the handling of mental health incidents. I hope equally that the Minister will wish to follow up on my noble friend’s suggestions.
The question of whether police officers, and only police officers, should exercise the powers under the Act to remove a person suffering from a mental health crisis to a place of safety is one that, as my noble friend Lady May said, has been simmering in the Home Office and the Department of Health and Social Care for a decade or more. Extending those powers to suitably trained healthcare professionals would be a change that I suggest goes with the grain of this Bill as regards the emphasis that it places on looking after mental health patients in the best possible way. That is not a criticism of the police in any sense. The police do a magnificent job in tackling anything that they are called upon to do, but, as we have heard, the police themselves say that the vast majority of instances in which they are called upon to deal with a mental health incident do not require a policing response.
The issue of risk is important to consider. Statistically, as my noble friend said, most mental health incidents present no risk whatever to the police attending. Admittedly, it is not always possible to tell in advance how risky a particular encounter is likely to be, but I agree with my noble friend that, provided that a paramedic is suitably trained and equipped, they will have the necessary skill set to deal with any risk to their own safety, bearing in mind that if a police presence turns out to be necessary, they can always call for one.
I very much hope that, between now and Report, the Minister will agree to meet my noble friend, if that is what she wishes, to map out a way forward that will lead to a broadening of the Sections 135 and 136 powers.
Baroness Merron (Lab)
My Lords, this has been an interesting debate, with much agreement across the Committee. I noted the support from both the other Front Benches, from the noble Earl, Lord Howe, and the noble Baroness, Lady Tyler, for much of what has been said.
Let me first discuss Amendments 37B, 38C, 42C, 42F and 128B in the name of the noble Baroness, Lady May, along with Amendment 158 in the name of my noble friend Lord Davies of Brixton. I am most grateful to the noble Baroness and my noble friend for bringing this issue before the Committee today. Amendments 37B, 38C, 42C and 42F would add a new category of authorised persons and would provide that police constables and such authorised persons may detain a person under Sections 2, 3 and 5 of the Act.
I share the recognition from the noble Baroness, Lady Barker, of the noble Baroness, Lady May, who I commend for her work to pave the way and dramatically reduce the use of police cells as a place of safety for those who are experiencing a mental health crisis. I listened carefully to the noble Baroness’s words of advice to all government Ministers; all I can say is that I cannot think how much better we could be advised than by a former Home Secretary and Prime Minister.
I thank the noble Baroness, Lady Watkins, for what I might call her notes of caution in respect of extending provisions, and the noble Lord, Lord Meston, for sharing his first-hand experience to add to the debate today.
We understand the broad intention of these amendments and of Amendment 128B, also in the noble Baroness’s name, to reduce police involvement in mental health cases for all the reasons that were said, including the extra distress that an officer may—inadvertently, of course—bring to a very delicate crisis situation.
The noble Baroness, Lady May, asked how the Bill will ensure that pressure is not placed unduly on police resource. I understand that that is very much a driving consideration, so let me say a few things on that matter. We recognise the pressure on the police, who are responding to a very large volume of mental health-related incidents, although—this is not to dismiss the point—detentions under Section 136 have decreased this year by 10%, and we are removing police cells as a place of safety to reduce some of this burden. We recognise, in particular, that police time in health settings should be reduced. I give an assurance that we have committed to look at this issue and to update the code of practice to clarify the handover process between police and health, including in A&E, which the noble Baroness, Lady Tyler, spoke about. We recognise the confusion around the application of the legal framework that can tie up police time when it would be lawful for them to leave a patient with health staff.
Baroness Barker (LD)
I thank the Minister for her characteristically full and attentive response. I understand why she is not too enamoured by my amendment, and I do not intend to push that much further. However, having listened to her response to the noble Baroness, Lady May, I cannot help but arrive at the conclusion that, while we are quite content, because we all agree, to see police officers being taken away, we are not going to change anybody else’s roles or responsibilities to plug what will be an inevitable gap. I return to something I have said today and previously: this will be the only mental health legislation for 20 years. If we let this go through, in the certain knowledge that we are creating a big gap which will not be filled by existing roles or the deployment of people within the NHS, we are being quite negligent. We are consigning a lot of people to finding themselves without appropriate support at moments of distress, and that goes for staff who happen to be around at the same time.
The noble Baroness, Lady May, is a fan of Geoffrey Boycott. I hope that she goes in to bat again and does not give up. There is an enormous gap here and we have just made it worse.
Baroness Merron (Lab)
I appreciate the contribution of the noble Baroness. None of us, including the Government, wishes to create a gap, either intentionally or unintentionally. I should have said in my remarks that the noble Earl, Lord Howe, asked whether I would meet the noble Baroness, Lady May, should she so wish. The answer is yes. I was glad to do so previously with the Secretary of State; it was extremely helpful.
I assure the noble Baroness, Lady Barker, that there is no intention to create a gap, and we would be happy to elaborate further. She is absolutely right to say that we should be cautious and that it would not be good legislation to do that. The challenge is whether the amendments before us are the answer. I hope that this is a helpful comment.
Lord Scriven (LD)
I have listened very carefully to the debate on this set of amendments. Those in the name of the noble Baroness, Lady May, would create a specialism within the relevant professions which is not there at the moment, based on a change of law. The Minister’s response was focused on the skills of people now, based on their generic roles. My question is this: in responding to the noble Baroness, Lady May, did officials and the Minister look at the potential change that would happen to the skill set, and at the skills and professionals that would be specific for this purpose? In practice, if the law changed, that is exactly what would happen to those professions: a subset of skills would develop, which would allow the gap to which my noble friend alluded to be closed.
Lord Davies of Brixton (Lab)
With your Lordships’ permission, I want to respond to what the noble Lord has just said. On the front line in this are the paramedics; they are the ones who will have to deal with this issue, most of the time. They need recognition for the additional work that they are already doing. The noble Baroness referred to the gap—the gap is being filled, but in a very inefficient and unrecognised way. We need to recognise that this is something that needs to be dealt with properly, with the staff involved being given the appropriate powers to deliver.
Baroness Watkins of Tavistock (CB)
To add to that, the key thing about paramedics is that they do not have long-term therapeutic relationships with the people we are talking about. Therefore, an intervention is totally appropriate.
Baroness Butler-Sloss (CB)
I too want to add, equally with great care, to this very interesting discussion. I am concerned about the police. I have not quite understood from the Minister her thoughts on a point that has been made twice now by the noble Lord, Lord Meston about everybody waiting for the police. Are the Government thinking of making it unnecessary for the police regularly to attend?
Baroness Merron (Lab)
I thank noble Lords for their interventions. To the noble and learned Baroness, Lady Butler-Sloss—how can I put this?—I say that the police should be there only when they are needed because they are the police. It is true—the point was made very well in the course of the debate introduced by the noble Baroness, Lady May—that it often goes beyond that. That is why “right care, right person” is something that colleagues are working on with police forces, as well as looking at the whole connection with health services. It is well understood.
I heard the comments of my noble friend, as well as those of the noble Baroness, Lady Watkins, following on from the noble Lord, Lord Scriven. When the noble Lord, Lord Scriven, was speaking, the words that came into my head were “chicken and egg”, about legislation and skills. We looked at skills, but—these are not quite the right words—not at the expense of addressing the question of whether the law is in the right place. They are connected, but I refer the noble Lord to the points made earlier, by me and the noble Baroness, Lady Watkins, about the response we have had from health and care professionals. It is about finding the right way. I take the point that there is a gap now. We do not want to make it worse, and we know that it is not acceptable.
Baroness May of Maidenhead (Con)
My Lords, may I say how grateful I am to all those across the House who have supported my amendments. When the Minister first stood up and started to respond, I got quite excited and hopeful. I thought the points had landed, but then, as she carried on speaking, my hopes were dashed as I realised that, in a very elegant way, she was actually rejecting all the points that I had made in my amendments.
The Minister emphasised the code of practice and dealing with the issue of the handover between police and medical professionals. The whole point of my amendments was to ensure fewer handovers between the police and medical professionals, because there would be fewer times when the police were called as the first responders to a mental health incident. The Minister kindly said she would meet with me, and I hope she might be willing for the noble Lord, Lord Davies, also to be part of that discussion.
The noble Baroness, Lady Barker, referenced my admiration for Sir Geoffrey Boycott. One thing about Sir Geoffrey Boycott was that his centuries tended to come quite slowly. Maybe the response and government reaction to this will be a little slower than I had anticipated; but, on the basis that I anticipate that that reaction may come and the century may be scored, I beg leave to withdraw the amendment.
Baroness Browning
Baroness Browning (Con)
My Lords, Amendment 43 in my name is to a list of grounds under which community treatment orders will be allowed. I have to say that, judging by the Second Reading of the Bill, including my own contribution, community treatment orders have not been a great success. I think that is a general view but here they are, listed in the Bill, and it is incumbent upon us to make them as strong and comprehensive as possible so that they are fit for purpose, if they are to remain.
I felt that there was an omission from the list of grounds in the Bill. I say to the Minister that I put my hand up immediately: I have had this this discussion with her outside the Chamber. This is something that I want to put into the Bill, but I am still not entirely sure that this is the right place for it. I hope she will not bat it out of—I do not know what to say in cricketing terms because I do not have my noble friend’s expertise in cricket. Anyway, I shall quickly move on.
We know the problem: there is a shortage of psychiatrists. In some areas, people are well served but in others they are not. Today’s debate has focused on psychiatrists who have expertise in autism and learning disability.
I am looking at a scenario where a person has autism or a learning disability, as well as a recognised mental health condition, and is discharged into the community on a community treatment order. Despite what I have said about my reservations about them in principle, because there is such a paucity of psychiatrists, particularly those who have expertise in autism and learning disability, once that person is being cared for on a community treatment order—or, for that matter, someone in the community who is not on a community treatment order but is medicated—where are the psychiatrists that they can turn to?
To my certain knowledge, there are around the country some integrated care boards that feel they are serving the autism community well enough if they can identify psychologists with expertise. There is nothing wrong with that, as there are excellent psychologists around the country, but of course, psychologists cannot prescribe. So there is a real challenge for people in that situation who need ongoing medication—the dosage of which may need to be changed, for example—having local access to an appropriate psychiatrist.
I am a bit nervous about the wording of the amendment—it is my wording, but I am still nervous about it—as it includes the word “local”. I assure the Minister that I am realistic enough to know that there is not going to be an appropriate psychiatrist just round the corner, but in many cases, as I am personally aware, there is not even anyone in the county. If someone has been subject to an in-patient stay in a mental health hospital, admitted in an emergency, that does not necessarily mean they are going to be in a local hospital; because of the shortage of beds, they may be quite far from home. So the community treatment order may not be exercised close to where someone has previously been an in-patient.
We also have problems at the borders between Wales, England and Scotland. For mental health services, there are mutually agreed agreements about where patients can be seen, and particularly where hospitalisation can take place. However, if community treatment orders are to be maintained, on discharge they may well be a long way away from where they live. That is why I have added my wording at the end of the list of grounds for community treatment orders.
We in Parliament make a great virtue of saying that decisions are made at local level. That is all well and good, but if the decision made at local level is, “We don’t need a psychiatrist within our geographic area who has that expertise”, that is not much help to the patient. I have shared with the Minister cases involving people who are not necessarily under a community treatment order but who have an ongoing need for medication and cannot access a psychiatrist with that expertise, and who end up having to travel to centres of population and paying very nice fees, thank you, privately because it is not available in any other way. That cannot be right, which is why I have added my wording to the list of grounds for CTOs. If the Minister does not think that that clause is the appropriate place for it, I will understand; but if so, I hope she will tell me where in Bill it should go, because I really believe it should be there.
As a postscript that has nothing to do with community treatment orders, for people with mental health conditions who need medication, people with autism without mental health conditions—I am looking away from the noble Baroness, Lady Murphy, at this point—and people with autism who need ongoing medication for, for example, autism-related anxiety, personalised medicine is going to be a real advantage, enabling them to know exactly the right drug and the right dosage. It is out of reach on the NHS at the moment, but personalised medicine, using DNA testing to get the right dosage, is very good. I hope we are going to see it pretty soon, particularly in mental health. Let us start with mental health. I beg to move.
Asylum Seekers: Hotels
(1 week, 5 days ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Lord Davies of Gower
To ask His Majesty’s Government when they intend to cease using hotels to house asylum seekers.
Lord Davies of Gower (Con)
My Lords, it gives me great pleasure to bring this debate to your Lordships’ House this evening. I am grateful to all noble Lords who are participating. The purpose of the debate is to question the Government on an issue that resonates deeply with communities across the country: when will they see the end of the use of hotels to house asylum seekers? This is a challenge which demands urgent action. It is not just about fiscal responsibility but about rebuilding public confidence in our immigration system, fostering community cohesion and ensuring Britain remains a nation of both compassion and order.
Let me state clearly: Britain has a proud history of providing sanctuary to those fleeing persecution. As the Minister will know, Wales is a nation of sanctuary. Swansea, where I hail from, is a local authority of sanctuary, which I know so well. We have welcomed in refugees from Afghanistan, Ukraine and Hong Kong, which, when in government, we could say we were proud of. But what we see today—a dependence on hotels as a stopgap solution—is neither compassionate nor sustainable.
First, let us address the financial burden. According to the latest Home Office figures, housing asylum seekers in hotels costs taxpayers over £8 million a day. This staggering expenditure is indefensible, particularly after a Budget which has increased pressures on employers, farmers and families, and reduced employment opportunities.
The Government should explain why this costly and inefficient approach is being allowed to continue, but we must also come to this debate with honest intentions. Yes, processing asylum claims was a challenge under the previous Conservative Government, despite it being one of our political priorities. With that in mind, I genuinely wish the Minister well in tackling this issue and I hope he is able to rise to the challenge presented.
Secondly, the impact on local communities cannot be ignored. From seaside towns to rural villages, hotels that once supported tourism and local employment have been repurposed as temporary accommodation. This has led to economic disruption, increased pressure on local services and growing frustration among residents. It now falls to the Labour Government to act decisively. At the last opportunity to question the Minister on this, I raised the enforcement unit. He did not have the figures on how many people were hired to date by the unit. I wonder: does he have the figures today?
The heart of this crisis lies in a broken asylum system over many years and many successive Governments, regardless of their political colour. This not only strains public finances but undermines confidence in our ability to distinguish between genuine asylum seekers and those seeking to exploit the system.
So, what should be done? First, the Government must accelerate the clearing of the asylum backlog. This requires more than resources; it demands clear leadership and effective management. Secondly, we must tackle illegal crossings at their source. Bilateral agreements with key countries are vital, as are robust deterrents and investments in border enforcement. However, while gathering intelligence is all well and good, it is useful only provided that it can be converted into practical arrests. I will be keen to see the Government’s progress on this subject and will continue to question them on it. Finally, fairness must underpin every policy: fairness to taxpayers, fairness to communities, and fairness to those who follow legal, safe routes.
The Government’s reliance on hotel accommodation for asylum seekers is an issue that needs addressing imminently. While we await the Government’s progress, this issue also highlights the challenges we faced, and must learn from, when we were in government. Now is the time for leadership. We must move beyond short-term fixes and deliver a comprehensive plan that restores order to the asylum system, strengthens our communities, and upholds the values that define our nation.
I will ask a couple of questions of the Minister. Following on from a previous Oral Question, which I am afraid still requires clarity, what measures are being implemented by the Minister to ensure local communities are consulted and supported during this transition? On the bilateral agreements that we have often been made aware of, what progress has been made in deterring illegal crossings and facilitating the return of individuals with unfounded claims?
I look forward to hearing the Minister’s response. I thank all noble Lords and I look forward to hearing from them in this debate.
Baroness Lister of Burtersett (Lab)
My Lords, I note my practical support from RAMP.
I fear that hotels, together with small boats, have become an obsession of the right, used by some to whip up hostility to asylum seekers, the dreadful results of which we saw last summer in the riots. The impression given is that asylum seekers are living a comfortable life in four-star hotels. Not so, as shown by three recent reports from the Helen Bamber Foundation and Asylum Aid, IPPR, and Women for Refugee Women. They paint a picture of “terrible living conditions”: unhygienic and dilapidated accommodation; overcrowding and lack of privacy, with enforced room sharing; very poor and inadequate food; and accommodation that is often unsuitable for children. Women, many of whom have fled gender-based violence, can be subject to various controlling practices, isolation from support networks, and degrading and voyeuristic behaviour from hotel staff. Overall, the effect is frequently exacerbation of mental health problems and re-traumatisation.
Of particular concern is the situation of children, including those wrongly assessed as adults, who are forced to share rooms with adults with no safeguards, to the detriment of their mental health. I gently remind my noble friend the Minister that he owes me a letter on this issue from when I raised it at Oral Questions in November.
I am not defending the use of hotels—far from it—but in the immediate short term they are at least preferable to even worse large sites, such as the “Bibby Stockholm”, which is thankfully closed now, and to homelessness, the lot of all too many asylum seekers when they receive refugee status. The extension of the 28 days move-on period to 56 days for a trial period is thus welcome, even if it means a longer stay in a hotel—though the consensus is that this should be made permanent.
In the longer term, the current policy of moving towards dispersal to community-based accommodation in collaboration with local authorities is the answer and has Local Government Association support. It chimes with calls from many groups and the Commission on the Integration of Refugees. I urge my noble friend the Minister to read the commission’s report if he has not yet done so. Also, is he considering triggering the break clause with private providers next year?
Finally, as noted at Oral Questions last week, an immediate step that would reduce pressure on accommodation would be to allow asylum seekers to undertake paid work after six months. The chair of the Migration Advisory Committee notes that if the laudable aim of processing asylum claims within six months is met it would cease to be relevant, but otherwise there is a strong argument from both integration and public finances perspectives. The standard Home Office response—that it would act as a pull factor—was dismissed by the Institute for Government as an example of policy based on “ill-founded assumptions” rather than good evidence. I am afraid I do not find my noble friend’s argument that he made last week—that it could lead to illegal work—very persuasive, either.
A new Government provides the opportunity to develop a comprehensive and positive integration policy for asylum seekers and refugees that would make the use of hotels redundant. This should be the priority.
Lord Green of Deddington (CB)
My Lords, I declare a non-financial interest as president of Migration Watch, but I shall speak personally today. This is a very difficult subject. Many good-hearted people have been working on these issues for years. Sadly, the situation has got steadily worse, and I suggest that it is now time for an entirely new approach, changing the legal system as necessary.
I will make four brief points. First, asylum is serious, but it is far from being the main issue. Legal net migration in the year to June 2024, at nearly 1 million, was more than 30 times the number who crossed the channel illegally in that year. It is high time that this massive legal inflow was tackled with the seriousness it deserves. At present, it seems that the Government are focusing on asylum to distract attention from the huge scale of legal migration that they have inherited.
Secondly, as regards asylum, it is absurd that we should accept, effectively without penalty, applications from asylum seekers who have destroyed their documents. As a result, claimants have a clear incentive to move on to the UK from the safe countries that they have already reached.
Thirdly, those who arrive without documents should no longer be accommodated in hotels, free to come and go and with some £40 a week to spend. Instead, they should be held in secure campsites until their cases have been decided. Any who left this temporary accommodation without permission should have their asylum claims automatically dismissed. The word would quickly spread, the numbers and costs would fall, taxpayers’ money would be spent on genuine cases and the numbers drowning in the channel would fall sharply.
This would be a radical change and would take time, but we simply cannot go on as we are—still less can we take the approach that the Government are now taking. I refer to the terms of the Refugees (Family Reunion) Bill, which is currently going through this House. As noble Lords will know, the current position allows entry to the UK only for parents, partners and children under 18. They have averaged about 6,500 a year over the past 10 years. The Bill proposes that family members of a person granted protected status should include parents, spouses, unmarried partners, children, adopted children and others dependent on the above. It even goes on to include
“such other persons as the Secretary of State may determine, having regard to … the importance of maintaining family unity”,
including
“the physical, emotional, psychological or financial dependency between a person granted protection status and another person”.
This is crazy. It is the exact opposite of what the present situation requires. The likely scale of the resultant inflow would have a very serious impact on community relations in this country. The public have had enough of being ignored by Governments on these matters. This Government would be well advised to amend their draft legislation and to do so soon.
Baroness Sugg (Con)
My Lords, the first issue I wish to address is the experience of women in asylum hotels. Like the noble Baroness, Lady Lister, I will highlight the recent report from Women for Refugee Women, Coercion and Control, which was the first of its kind to specifically examine the treatment of asylum-seeking women in hotels. The noble Baroness explained some of the deeply concerning findings from the report.
The impact on women’s mental health is severe. According to the report, 91% of women felt anxious or depressed and nearly half had suicidal thoughts. As the Minister will be aware and as the noble Baroness highlighted, many of these women have fled horrific circumstances and endured a traumatic journey to the UK. What they are now experiencing in hotels only compounds their suffering. The report calls for an end to the use of hotel accommodation, immediate action to address its harmful effects and the provision of safe and supportive accommodation. I welcome the Government’s commitment to prioritise survivors of gender-based violence and ensure that they receive the support they need. Can the Minister reassure us that this will include survivors who are seeking asylum?
My second point concerns the financial impact of hotel costs on the UK’s important work overseas. In 2023, the Home Office was allocated nearly £3 billion, or 20% of official development assistance. The UK reports the highest costs per refugee of any country—over 30% higher than the next-highest country, Ireland, and 150% higher than the next-highest G7 country. These statistics highlight the need for urgent action to control costs. Of course I acknowledge that it was a previous Conservative Government which cut the development spend from 0.7% to 0.5%—a decision I deeply regret—but our in-country refugee costs, the vast majority being hotel costs, were partially offset by the previous Government in the 2022 Autumn Budget, with an additional £2.5 billion in ODA funding to help manage the pressure on refugee services. Despite comparable pressures now, this additional funding was not repeated by the Government in their Budget in the autumn, leaving the FCDO facing, yet again, significant and sudden cuts to its programmes.
I very much welcome the news earlier this month of an additional £540 million of funding for the FCDO, which, thankfully, avoids hitting a 17-year low in spending on our overseas programmes. This amount was from the increase in gross national income and a fall in spending on domestic refugee costs. I know that the Minister supports transparency in government spending, so can he clarify how much of this £540 million was due to the fall in spending on asylum hotels?
Success in our development work benefits not only the countries we work with but also us here at home. Done right, it can help to tackle many of the drivers of illegal migration in the first place. But it requires certainty and long-term planning—something that, sadly, has been impossible in recent years. This is yet another reason to urgently reduce the backlog and move to ending the use of hotels for asylum seekers.
The Lord Bishop of Sheffield
My Lords, I declare an interest as the patron of the charity ASSIST Sheffield. In the interests of time, I will limit my remarks to three key points.
First, there is the question of safety. One of the communities I serve as the Bishop of Sheffield is Rotherham. Noble Lords may recall how, in August last year, a group of asylum seekers living at the Holiday Inn in Manvers were deliberately targeted, in an incident that led to criminal convictions for over 60 men. The following month, at the request of the Mayor of South Yorkshire, I arranged for one of the churches in Sheffield, Christ Church Fulwood, to offer sanctuary for the day, free of charge, to a group of asylum seekers because there were fears that their hotel could be subject to a similar attack. Quite simply, it subjects asylum seekers to danger if they are placed in hotels in visible numbers. Dispersed accommodation offers greater protection and, for that reason, we should move to that provision as swiftly as possible.
Secondly, hotel accommodation by and large inhibits rather than promotes the integration of asylum seekers into local communities, and it increases rather than decreases their sense of isolation and precariousness. I am grateful to the Minister for acknowledging the need to transition from hotels to dispersed accommodation, and for affirming the observation of the noble Lord, Lord Young of Cookham, last week that asylum seekers are not currently well integrated into local services—but the two are connected. Noble Lords will be aware that, in 2024, nearly 7,500 unaccompanied children seeking asylum were in the care of local authorities across the UK. May I press the Minister and ask what actions he is taking to engage in mutually constructive discussions and consultations with local authorities to provide asylum seekers with sorely needed access to support services and continuity of place, not least to ensure the welfare of unaccompanied children?
My third and final reflection is that it is worth emphasising that the substantial costs associated with the use of hotel accommodation reflect the backlogs and delays resulting from a dysfunctional asylum system. In other words, the asylum seekers themselves are not to blame for the strain on the public purse. In any case, each is an individual created in the image and likeness of God, to be treated with the utmost dignity and respect—especially in view of their very real vulnerability. Frankly, it would be not only a better use of public funds but a better expression of care to seek to move as quickly as possible from hotel accommodation to dispersed accommodation. I urge the Minister to urge the Government to accelerate that process.
Lord Empey (UUP)
My Lords, I have considerable sympathy with the Ministers of this Government and previous Governments with regard to hotels. However, the Minister answered a Question last week and I got a sense of complete complacency, not only in Parliament but in government, about the position that all this immigration is leading us to. The truth is that the system is completely out of control and has been for some considerable time. We talk about dispersed accommodation and integration, which I fully support, but if you have 20,000 people per week coming into the country, how do you disperse and integrate them? The numbers are just uncontrollable, given the shortages of accommodation that we already have.
Then we say, “Well, we’ve got waiting lists in the health service”. Of course we have waiting lists in the health service. If you are increasing your population at that rate, how could it be anything else? The question is a basic one and it goes back to the fact that it is gangsters who are running these people, taking money off them and putting them into harm’s way in the channel in the hope that they will get to the other side, although they have already pocketed the money. Although the Government have made a commitment that they are going to tackle that as their number one priority—the Prime Minister has been very explicit about it—I would like to hear from the Minister what progress has been made.
We have a long tradition, of course, of opening our doors—it goes back to the Kinder trains in the 1930s and 1940s; of course, the noble Lord, Lord Dubs, is one of the shining examples of the success of that—but as a country, we just do not have the capability or capacity to deal with the numbers and we are just not facing up to it. Look at what is happening around the world; look at what is happening today in the United States and why it is happening. Look at what has happened in other countries in Europe and look, in a few weeks’ time, at what might happen in Germany. We cannot just keep sweeping this under the carpet.
Part of the problem goes back, I think, to the good will that was genuinely expressed over 70 years ago when we were dealing with the 1951 refugee convention. On 30 July last year, I asked the noble Lord, Lord Collins of Highbury, a Written Question:
“To ask his Majesty’s Government whether they are discussing with other countries amendments to the 1951 Refugee Convention to take into account the changed world circumstances”.
The Answer was:
“The Government is not discussing amendments to the Refugee Convention with other countries”.
Why not? It was done with good will and the right intentions quite a number of years ago, but it is out of date and we need to address it. I hope the Minister can give us some comfort on that.
We are under international obligations, and that is why we need an international solution, but we also have national obligations. We have just taken a heating allowance of £200 a year off pensioners who are earning just over £12,500 a year, yet it costs £145 a night to house anybody who comes in on a boat, and they also have access to our health service and so on, while other people in our own community do not. We have to be compassionate on one side, but we also have to be realistic on the other.
Lord Patten (Con)
My Lords, it has become something of a trope to call the first day of the third week in January—that is today—Blue Monday, when people feel at their lowest and nothing much works. Sometimes people make that accusation of migration policy. When I got to work today, I was cheered, in the office where I am, to see that the people who run the building were making a valiant effort by turning Blue Monday into what they called “Brew Monday”. None the less, I think today is appropriate to debate the horrendous growth in the cost of housing asylum seekers in hotels. This is still a fast-growing practice and it represents just the very tip of the iceberg of migration policy in the UK.
A generation ago, the problem seemed possible to handle. Numbers were much lower, and they were easily divisible into asylum seekers generally fleeing persecution and economic migrants seeking betterment; no more. The escalating numbers all seem to claim to be genuine asylum seekers needing lodging, while the ever-lengthening queue waits to be processed. The situation we are in is a major state failure by all parties, for government, political parties, think-tankers and policymakers are nowhere near a solution to the situation that faces us, despite great efforts, which I recognise, much thinking and huge expenditure. In saying this, I make no partisan attack on the Benches opposite; I assure the noble Lord, Lord Hanson of Flint, of that.
All parties have had a go over the past 40 years, but when good ideas have emerged, such as using more redundant military camps, in the end, both major parties, Labour and Tory alike, have balked in the face of “No migrants in my backyard” protests. We might be a bit better off if we had not collectively balked at that. Of course, there have been all the headline-seeking suggestions about leaving the ECHR. Sure, some of those who make it to our shores might be easier to remove, but to send them back to where? It is a practical issue, and it is unlikely to stop migrants making the attempt in the first place anyway.
So, at the beginning of what I think over the years will come to be called “the long Parliament”, between now and 2029, it is absolutely right that my noble friend Lord Davies of Gower should have introduced this Question for Short Debate. I want to ask the Minister whether HMG now—I cannot quite see it and I am happy to be educated by him, as he has done in the past—have a clear plan, underpinned by verifiable, practical policies, to have at least reversed, no better than that, present trends by Blue Monday 2029.
Baroness Hamwee (LD)
Sorry, the communication obviously was not good enough.
Baroness Hamwee (LD)
As there is the opportunity to speak in the gap, perhaps I may respond to some comments of the noble Lord, Lord Green of Deddington, regarding the Private Member’s Bill, for which I must take responsibility and not load it on the Minister.
The Bill is concerned primarily with allowing children to sponsor their parents to come to this country—currently, parents can sponsor children, as he said. Much of the rest of the Bill reflects what is in the current rules. The extra numbers involved are difficult to estimate, but the Refugee Council, the Red Cross and Safe Passage have given an estimate of, from memory, a lower figure of 340 a year and a maximum figure of 750.
The noble Lord shakes his head about the reflection of the current rules. To give him just one example, when I looked at them, I was surprised to see that the term “emotional well-being”, which I think he may have mentioned, is in them; I was quite encouraged to see that.
More generally, and I know that my noble friend will say everything I would want to say and probably more—and better—asylum seekers cannot just be a matter of numbers for us, given what is going on globally with conflicts and so on. This is where the debate seems to always land. I want to put on record at least a response to the noble Lord; I am actually grateful to him for having read the Bill.
Lord German (LD)
My Lords, I am grateful to my noble friend for poking me on the shoulder, because my hearing aids were slightly inefficient in this process. I first declare my interests as set out in the register, that I am supported by RAMP. I am grateful to my noble friend because underpinning all the discussion today is the fact that we are talking about human beings here. We are talking about people who are fleeing for their lives or fleeing from danger in a way that we cannot actually assimilate, unless you have made those connections and seen it at close hand.
This has been an interesting debate. It has spread beyond the Question that the noble Lord, Lord Davies, tabled, so I would like to focus on the issues. First, there is an acceptance that for people fleeing from these disastrous situations, long-term accommodation in hotels is just not suitable, particularly for families and children. While people are waiting for their asylum claims to be considered they should have safe, secure accommodation where they can cook for themselves and easily access local support and services and there is local support available from many sources. It is from this context that they will be more able to engage with the asylum process itself, effectively present their case for protection and start to feel secure and stable. It is true that accommodating asylum seekers in hotels is not appropriate for the communities in which they find themselves. It is also deeply unsuitable for the individuals themselves, so this situation has to be changed and altered.
One of the reasons why, which the noble Baroness, Lady Sugg, mentioned, is the cost to the other services we provide in the rest of the world. Our overseas development budget has already been pulled back to 0.5% from 0.7%, and I hope that we can get back to it, but huge chunks of that money have been used inside the United Kingdom and diverted from the sort of work which might help people not to make the journeys to other countries by improving their quality of life closer to home.
Last Thursday there was an Oral Question in which I talked about the opportunity of reducing reliance on hotels for asylum seekers by giving them the ability to pay for their own accommodation by granting them permission to work, and the Minister will not be surprised that I am returning to this matter. In the Minister’s reply he said:
“Sometimes … asylum seekers could be put in positions whereby they are undertaking work they have no legal right to do”.—[Official Report, 16/1/25; col. 1268.]
On these Benches, we support the three measures the Government are taking: cracking down on the gangs, producing shorter waiting lists and providing dispersed accommodation. Those are all perfectly proper. We would like to see the Government moving a step further, as the Government’s chair of the Migration Advisory Committee has said, by giving permission for people to work while they are waiting. There must surely be ways in which the Government can deal with what they think might be the problem. They say it might be a push factor, but there is no evidence of that. In fact, we are the outlier: we are one of only three countries in Europe which do not allow people to work.
The other area I think the Minister will be concerned about is people disappearing, but I believe that the opposite will be more likely. When people are in some form of secure work, they are not going to try to disappear into the black economy. I hope the Minister can produce evidence to the contrary of the assertion I am making, but there is no evidence that this will be the case.
In conclusion, I agree that the ideal would be to have asylum claims decided right first time, but within six months is clearly not happening. It is taking longer and longer, and the appeals backlog is causing that to happen. So can we expect the Government’s proposals in their White Paper to actually address some of these very key issues we are raising in this debate, particularly about how we are going to deal with people who are here in that queue, waiting for their decision to be made?
The Minister of State, Home Office (Lord Hanson of Flint) (Lab)
I am grateful to the noble Lord, Lord Davies, for giving us an opportunity to debate this issue. We have had a number of Questions on it, but it is worthy of a debate in this short time we have. I will try to answer the points that noble Lords mentioned in their contributions.
If the noble Lord will forgive me, I will start with the noble Lord, Lord Patten, who asked whether we have a plan to look at blue Monday five years hence. I hope it will help him and the noble Lord, Lord Davies of Gower, if I mention some points very briefly, which I hope will satisfy the noble Lord, at least in part.
First, we have to speed up asylum claims, because they are taking too long to be determined. As my noble friend Lady Lister mentioned, we have a proud record of accepting asylum claims, but we have to adjudicate them. The longer we take to adjudicate them, the longer people need to be in hotels and dispersed accommodation. So the first task the Government have to undertake is to ensure that we complete and assess asylum claims as quickly as possible. To do that, we have put in an extra 1,000 staff, deployed from different parts of the department, in part from the savings from the Rwanda scheme which was scrapped.
Secondly, we need to speedily remove those who do not have a claim for asylum. Since 4 July, the Government have taken 16,000-plus people who have failed the asylum system from hotels and returned them to a place of safety—a country that they have been deemed able to return to.
Thirdly, and this is the nub of the discussions we have had so far, we need to look at how we close hotels, because they are a costly way of operating asylum accommodation. We have already closed the “Bibby Stockholm” and scrapped the use of Scampton in Lincolnshire, and we have plans to reduce the number of hotels over the course of this Parliament. It will take time, but by March this year we will have nine fewer hotels than we inherited in July last year. The noble Lord will expect me to say this, but I find it strange that under his jurisdiction and his Government, the number of hotels went from zero in 2015 to a peak of 400 in 2023 and is now just settling at the 260-270 mark. There is a record that we have to pick up on and work with, which I am trying to do in a constructive and positive way.
To answer some of the points mentioned by the noble Lords, Lord Empey and Lord Green, we have put in place the new Border Security Command—which will require legal back-up in a Bill later this year—with Martin Hewitt as its head. That is designed to try to take some of the pressure not off asylum accommodation, which is legitimate, but the illegal entry to the UK by criminal gangs organising for people to make dangerous crossings to potentially seek asylum, who in some cases have no basis for asylum but still come across in illegal gangs. The Border Security Command will be part of the plan to try to overturn that.
The noble Lord, Lord Davies, asked about what we are doing with our international partners, and we have some international policy objectives. We do not have a phobia about talking to Germans, Italians or the French. We have a Calais Group in place to look at the issues there. Our Border Force control is looking at what is happening in Germany, working with Germany upstream to reduce the pressures there and to ensure that people claim asylum legitimately in their first port of call, rather than coming to the United Kingdom.
We have scrapped the Rwanda scheme, which was a disincentive and a waste of money. We have put that money into the areas I mentioned to the noble Lord, Lord Patten, such as speeding up asylum claims, finding places to reduce the use of hotels and commissioning good, dispersed accommodation. I take the point mentioned by the noble Baroness, Lady Hamwee, and the noble Lord, Lord German, that we want to get people through the system as quickly as possible, so they are determined to be legitimately here and able to work, or not legitimately here, and a way is found to deport them. That process needs to have integrity and speed.
There are issues arising from and discussions about the levels of migration, as mentioned by the noble Lord, Lord Green. The Refugees (Family Reunion) Bill, which is a Liberal Democrat-inspired Bill, not a Government Bill, has legitimate objectives at its core, which I accept and understand. A big migration White Paper is due shortly; it will look at the very pressures that have been talked about in this House by my noble friend Lady Lister and the right reverend Prelate the Bishop of Sheffield, and at how we deal with integration and the potential shortfall in skills. It will consider how we deal with asylum issues generally, all the questions that are dealt with in the family reunion Bill, and how we create a wider 5-year plan—going back to the noble Lord, Lord Patten—to ensure that we can deal with those issues over that period. Those are all key issues.
To the noble Baroness, Lady Sugg, the right reverend Prelate the Bishop of Sheffield and others who have mentioned it, I say that the hotel costs which are the focus of this debate are simply eyewatering and not a good use of taxpayers’ money. As the noble Baroness, Lady Sugg, mentioned, they are not even a good way of ensuring the safety and security of the people in those hotels, particularly women fleeing persecution. The costs were £8 million per day under the previous Government. They have dropped to £6 million per day following the work we have done to reduce them. It will take time but, I say again to the noble Lord, Lord Patten, it is part of the plan to get that figure right down and, over a period, end the use of hotels, but we have to deal with the demand issues first. These include legitimate asylum claims, which my noble friend Lady Lister mentioned; we should be place of sanctuary, somewhere that accepts people who are fleeing persecution, and do so in a proper and effective way without hotels.
We have to be cognisant of the fact that we still have to deal with the continued demand, as has been mentioned by a number of noble Lords, including the noble Lord, Lord Empey. We need to focus on reducing the pressure on the system from those who are seeking to come here illegally.
We have increased dispersed accommodation by 8% in the past few months of this Government’s tenure—the first time that we have been in office to do so. Millions of pounds of taxpayers’ money had already been spent on large sites at Scampton and Bexhill, and the “Bibby Stockholm”, by the previous Government, and we have tried to row back on that. We have reviewed asylum spend, and it is important that we look at the bigger picture. In 2023-24, when the noble Lord’s party was in office, the Home Office spent £4.7 billion on asylum support, the vast majority on hotels. We are continuing to explore how we can save taxpayers’ money, and we are on track to save £4 billion over the next two years. I can tell the noble Lord, Lord Patten, that it is part of the plan to reduce the amount of money spent on asylum accommodation by speeding up the claims, scrapping accommodation such as the “Bibby Stockholm” and ensuring that the Rwanda policy is changed, so that we can use that resource to clear the backlog of asylum decisions.
I thank the noble Lord, Lord Davies, for securing this debate. This Government inherited an asylum system under exceptional strain. When we came into office, there were tens of thousands of cases at a complete standstill, and a growing a backlog. In reference to the point made by the noble Lord, Lord German, asylum seekers were therefore living in limbo, accommodated in hotels which not only cost exorbitant sums but are profoundly detrimental to the wellbeing of vulnerable individuals, as the noble Baroness, Lady Sugg, mentioned. The right reverend Prelate the Bishop of Sheffield highlighted that there is real pressure on hotels from collections of individuals, which has led to forces that are not conducive to integration, security and acceptance. The focus has been on hotels rather than on dispersed accommodation, where people go about their daily lives in a dispersed way.
For all those reasons, the Government are actively working towards a more sustainable and cost-effective solution to accommodate asylum seekers away from hotels. I have to be honest with the House: it will take time. It is a challenge, and it cannot be done straightaway, but the Government’s objective is very clear. In the manifesto, we said that we would end the use of hotels for asylum accommodation and, at a date to be determined, that we will do. I will be accountable to this House, as my right honourable friend the Home Secretary will be to the House of Commons, in ensuring that we do that in future. The resource that is being eaten up by asylum hotels is the very same that, as the noble Baroness, Lady Sugg, mentioned, can be used elsewhere for more positive activity. I will look at the detail of what she mentioned and drop her a note.
I will check on my noble friend Lady Lister’s lost letter. I thought I had sent it, but maybe it got lost in the system over Christmas and the new year. We will find out where it has gone, and if it does not have a stamp on it yet, it will have one shortly. She may even find that I use the new method of email, as a matter of some speed, to get the correspondence to her in short order. I will look at that as a matter of urgency and get back to her.
I hope that today’s debate has been useful. There are challenges. On all sides of the House, we accept that we have the challenges of wider migration, hotel accommodation and its cost, making a plan and illegal migration into this country. In the short time that I have had, I hope I have set out the Government’s prospectus. With that, I hope that the House can hold me to account in due course on the delivery of that proposal.
Baroness in Waiting/Government Whip (Baroness Anderson of Stoke-on-Trent) (Lab)
There is some time.
Lord Hanson of Flint (Lab)
We have time. As I have known the noble Lord, Lord Empey, for such a long time and worked with him in such a constructive way, and even though the clock is flashing, I will take his intervention.
Lord Empey (UUP)
Before the Minister sits down—again—could he respond to my point about the 1951 refugee convention. He talked about demand. This is part of the legal framework and our international obligations, which I think need revision, with our partners across the rest of the world who were party to it in the first place. If he cannot give me a response now, he can write to me—or email me.
Lord Hanson of Flint (Lab)
We will uphold our international obligations. We have an international obligation, under international law, to accept and assess refugees. That does not decry the fact that we have to look at, with our European and United Nations partners and others, how we reduce the pressures that lead to refugee status in the first place. I will certainly reflect on what the noble Lord said and look at Hansard in due course, but this Government will keep to their international obligations.
I am grateful for the debate and do not wish to test the patience of the House. Having had my 12 minutes, I commend the debate and hope that I have been able, at least in part, to answer some of the important questions raised.
Mental Health Bill [HL]
Monday 20th January 2025
(1 week, 5 days ago)
Lords ChamberRead Full debate Mental Health Bill [HL] 2024-26 View all Mental Health Bill [HL] 2024-26 Debates Read Hansard Text Watch Debate Read Debate Ministerial Extracts Amendment Paper: HL Bill 47-II(a) Amendments for Committee (Supplementary to the Second Marshalled List) - (17 Jan 2025)
Lord Scriven (LD)
My Lords, I will speak to my Amendment 44 in this group. Having listened at Second Reading, I was minded to table this amendment based on my noble friend Lady Parminter’s speech giving her real-life experience of the need for community treatment orders. Both the amendments and the Second Reading debate show the wide range of views on community treatment orders, ranging from some who feel they are not needed to those who feel that they are needed and those who feel a review is needed. However, something in the present system is not quite right, so, again, this is a probing amendment to try to understand where the Government’s thinking is.
Given that, even if a review were to take place, CTOs would still exist, my amendment would in principle provide an initial 12-month period for a community treatment order with some very clear provisions. If we are going to have these provisions, they need to be on the face of the Bill rather than in the code of practice—even if they are not the provisions in my amendment. I suggest that the initial order is for 12 months and that, before the order is made, the patient has to be consulted, as well as
“the patient’s nominated persons, and any relevant mental health care professional involved in the patient’s treatment or care planning”.
Importantly, the CTO has to be in line with the necessity for therapeutic benefit, and it has to involve consulting a second medical professional. I understand that the wording of the amendment may not be correct, because a particular type of medical professional, a psychiatrist, would need to be consulted with regards to the community treatment order and whether it will have therapeutic benefit.
I suggest that, at the end of the 12 months, if the clinician feels that an extension is needed, a review takes place, which goes through the process that I have just outlined—to ensure that there is therapeutic benefit, and a second medical practitioner is consulted—and that it is then reviewed after a maximum of six months. That is absolutely right in terms of trying to ensure that the therapeutic benefit is central and a second medical opinion is provided, particularly at the review stage, to ensure that there is a need for the CTO. The reason for this is the wide range of views on CTOs but also the statistics regarding the racial discrimination that there appears to be around their use, which is well documented and well evidenced.
I look forward to the Minister trying to explain the Government’s thinking on community treatment orders and how they need to change. Clearly, something is not quite right in the implementation, the length of time that people are on CTOs and whether CTOs have therapeutic benefit for many of those who are on them.
Baroness Bennett of Manor Castle (GP)
My Lords, I will speak to my Amendments 67 and 86. I think that this is the right place—I apologise for my earlier confusion; I had a problem with the list.
I will start with Amendment 86 because it follows on from the very important contribution from the noble Lord, Lord Scriven. I should preface this by saying that I cannot claim that what I will say originates from me; it is based on the Law Society briefing, which many noble Lords will have received. I saw that nobody else had picked up this amendment, but I thought that it was so important that it should be picked up. As the explanatory statement says:
“The amendment would keep the safeguard of an automatic referral to the tribunal when a patient’s Community Treatment Order is revoked which results in them being detained in a mental health hospital”.
As the noble Lord, Lord Scriven, said, a range of views on CTOs has been expressed in these debates, but the general direction of travel is certainly not to remove safeguards and we should be keeping the safeguards that already apply. I will not claim great expertise on this, but it seemed to me that this is an important issue that we need to discuss in Committee.
Amendment 67 is somewhat different but really important. Later on, we will discuss very important issues, which I have signed amendments about, concerning minoritised communities being potentially overtargeted or subjected more to mental health provisions. This amendment picks up something that no one else has picked up, which is economic and social disparities relating to community treatment orders. I went looking for some statistics on CTOs in disadvantaged communities, but I was not able to split them out; perhaps the Minister has them. However, the charity Rethink Mental Illness talks about the burning injustice of how Mental Health Act detention rates are three and a half times higher in the most deprived areas of England compared with the least deprived. Looking at those figures, I can only see that CTOs must be something very similar to that.
We need to ask a question here, and we need the stats and that is why we should have the reporting. It is probably unclear whether we have a psychiatrisation of poverty, so that when people are living in conditions of poverty, that is seen as some form of mental illness in itself, or a discriminatory application of the law against people living in conditions of poverty. The third possibility is that poverty is making people ill. Either way, we should know about these facts. They should be regularly reported, and we should be able to examine them and check on them.
I was just looking at an issue that will be raised later about debt and mental health, on which I will point noble Lords who have not seen it to a really interesting POSTnote that the Parliamentary Office of Science and Technology produced on that subject last year. It suggests a two-way relationship between financial and mental well-being. People with mental health issues are three or more times more likely to have problem debt.
Some interesting recent research in a study published in Public Health indicates how social conditions are related to mental health. “Sandwich carers” in the UK —the 1.3 million people who have responsibility for caring for children and older parents—have experienced a significant decline in mental health.
These issues around social and economic disparities and the use of community treatment orders are embedded in the community, and it is crucial to see what is happening. Amendment 67 aims to ensure that we get regular reports relating to community treatment orders.
Baroness Fox of Buckley (Non-Afl)
My Lords, I wanted to speak to this group because I made some harsh criticisms, on principle, of community treatment orders at Second Reading concerning their coercive and intrusive nature. Since then, perhaps similarly to the noble Lord, Lord Scriven, I have had cause to think again, not least after speaking to a number of working psychiatrists and taking on board the comments of the noble Baroness, Lady Parminter, at Second Reading, which really had an impact on me. It is quite unusual to change one’s mind in this place—maybe it is just me—so I wanted to note that.
I was reminded of this issue by practitioners—I was once one of those—when they said, “We worry about how many idealistic discussions about mental illness just do not take into account the reality of chronic mental illness”; I thought that was a fair reprimand. There are a group of people who are chronically symptomatic, perhaps some of them may never be well, and CTOs are a way to allow people to leave hospital who otherwise clinicians might worry would be too risky to release.
I have been thinking about this issue and in that sense was happy to see and support Amendment 44 in the name of the noble Lord, Lord Scriven, which sets out time limits. It is useful to think about probing time limits, renewal safeguards and so on, because one does not want automatic continuation and therefore indefinite CTOs on the books, which is what people are concerned about.
I would have been more enthusiastic about Amendment 66, put forward by the noble Lord, Lord Kamall, and the noble Earl, Lord Howe, which calls for a statutory review of CTO use, but the wording implies that CTOs are problematic per se. Perhaps we need a more open-ended review, because one of the reasons why CTOs are so contentious for so many people is their spiralling and increasing use, and we need to understand why that is.
One worry I have about the Bill in general, and not just this group of amendments, is that, because the drivers of the legislation are concerns about inappropriate hospital admissions and wanting to ensure that we have proportionate detention powers which are used only as a last resort, we need to be wary of demonising hospital care and recognise how much good can be done for mentally distressed patients in hospitals, particularly if they are given time and resources and the right kind of medical intervention. But, as with all hospital matters, that is not necessarily what is happening. Many psychiatric wards are under pressure to get people out into the community as soon as possible—in the sense not of them being well, but of freeing up hospital beds. One might wonder whether the CTOs are a mechanism for effectively turfing patients out before they are ready or well enough.
It also seems that CTOs are necessary when community care is under huge strain, because the idea of voluntarily accessing a wide variety of support in the community is a myth in today’s circumstances. All the briefings we have been sent draw attention to this. A range of groups and people have argued—and a number of noble Lords have said this today—that we need more resources, money and staff for appropriate care in the community to really work. That sounds reasonable, but I am concerned that this will miss the target. I want to reiterate the elephant in the room that I mentioned at Second Reading, which I have not changed my mind about: culturally, we are seeing the medicalisation of more and more problems of the human condition. This encourages ever greater numbers of people to view social, economic, educational and personal difficulties through the prism of mental health.
Baroness Berridge (Con)
My Lords, I support Amendments 44 and 66. The Joint Committee on which I serve recommended that community treatment orders be abolished for Part II patients. That recommendation is supported by organisations such as Mind. That is partly due to the awful racial disparity statistics—you are up to 11 times more likely to be under a CTO if you are from a black or Caribbean background—combined with a lack of evidence that CTOs reduce hospital admissions. It took a brave gulp, even as the Joint Committee, to recommend that. The independent review had not gone as far as that, but it was in the report of the Joint Committee.
I, too, like the noble Baroness, Lady Fox, recognise the powerful speech of the noble Baroness, Lady Parminter, at Second Reading. I remember that, because of the extremely tight timetable the Joint Committee was given, it did not have time to consider in detail eating disorders or personality disorders, which was regrettable.
I can see from the reasons the noble Baroness outlined that there may be a case for retaining CTOs, perhaps even just for eating disorders. To quote her words from Second Reading, a CTO
“puts a boundary around the eating disorder … that a voluntary agreement could not, in that it makes it clear what will be the result”.—[Official Report, 25/11/24; col. 555.]
The Bill outlines protocols for specific treatments, such as ECT, so it seems possible in principle to have the law apply to specific disorders.
Most reluctantly, I have not made an amendment in Committee in support of the Joint Committee’s recommendation. But the independent review stated that “action is required”. We must not lose sight of that urgency. There are significant problems with CTOs. The argument that is proffered—that they help and are the least restrictive measure for a very small number of patients—is not a good basis for retaining them, bearing in mind the enormous harm they are doing on the other side. I ask the Minister to look for another way, going forward, to help this small group, and not to ask racialised communities to, once again, pay such a high cost for such a small group of patients.
In the Joint Committee’s report, it seemed that the group of patients we were talking about were unrestricted patients under Part III of the Act. Bearing in mind that 79% of CTOs are under Part II, which is for civilian patients, can we look in detail at the evidence to find out which small group of patients we are talking about? There are particular issues, according to our report, if a restraint or restriction is being used on people when the small group of patients seems to be within the forensic context rather than under Part II.
I ask the Minister to put CTOs where they need to be, as a result of these amendments. The independent review said that they should be in the last chance saloon. We must be careful not to lose the urgency that the independent review gave to these issues. Although I support Amendment 66, tabled by my noble friends, it is the very least we can do. The restrictions outlined in Amendment 44 are about ending them after a certain period, because part of the problem is that they go on and on, rolling over for years and years. That coercive effect on certain communities seems to remain, as the path of least resistance.
Baroness Parminter (LD)
My Lords, I want to say a few things about a couple of the amendments. I thank noble Lords for listening and for recognising the situation. It was powerful to hear that, and I am sure that many in the eating disorder community will be delighted to hear it.
I will not repeat what I said at Second Reading, as there seems no need, but in mentioning that, I want to support the amendment tabled by the noble Baroness, Lady Browning, which picks out the focus on community care and the need for more psychiatrists. I and others have made the case for why CTOs can be valuable for people with eating disorders—and for forensic patients, I understand. The value of the CTO is that the individual is helped to engage in the community with their mental health team. It is a multidisciplinary team, but the anchor is the psychiatrist. The noble Baroness was not sure if this was the right place to put her amendment because it has wider ramifications, but it certainly has value in this debate. CTOs, which I believe should be retained, can work only if there are proper multi-disciplinary teams anchored by a psychiatrist in the community, so that those individuals can be kept out of detained settings and engaged in the community. I thank her for bringing that forward, and I support it.
With regard to Amendment 44, I do not support a maximum duration for a community treatment order, because this is about the individual and what they decide, with their multidisciplinary team. What I like about the amendment tabled by the noble Lord, Lord Scriven, is that it rightly says that we have to review community treatment orders. People’s mental health situations change, and it is important to have step points at which people know they will be reviewed. I do not support a maximum time limit but the break points, which his probing amendment talks about, are worthy of further debate and discussion. I am grateful to him for bringing that forward.
I say with regret that I do not agree so much with the support of the noble Baroness, Lady Bennett, for retaining the automatic referral to a tribunal of any CTO that is lifted. Again, that goes against my sense that CTOs are about what is right for the individual. With eating disorders, there will be cases of CTOs being lifted because the person is no longer able to engage with the community team because the eating order has gone beyond the bounds of the CTO and is compromising their health and putting them, bluntly, at risk of death. I do not see why, in those circumstances, there needs to be an automatic referral to a tribunal. Strengthening people’s rights to go to a tribunal where there is a case for that is right and proper, but, because of my view about personalised care—especially for eating disorders, but this has wider ramifications—I do not support the case for automatic referral.
I know that there are people around the Committee who understand the concerns far better than me, particularly about the high preponderance of people in the black community who are on CTOs. I understand and hear that concern. I tried to get to the bottom of the figures, like the noble Baroness, Lady Bennett, to find out how many forensic patients were on CTOs. Given that you are four times more likely to be in prison if you are a black person than a white person, I tried to work out what the figures were to get the correlation to say whether it is because there are more people in prison that CTOs are preponderantly in the black community. I could not work that out. Equally, I could not work out how many people with eating disorders were on CTOs. I got the Library to try to help me, and it said that the figures are not cut that way and do not work that way. It seems to me that there is an issue about the data that we, and the Minister, are working with to make informed decisions.
I am not sure about the exact terms and conditions of the review that has been proposed by the noble Lord, Lord Kamall, and which in a later group is proposed by the noble Baroness, Lady Tyler, but I think there is an issue about the data out there. It is not helping us, or anyone else, make CTOs work for those where they can work, are working and should work in the future, and is clearly causing a problem. We need to get to the bottom of that.
Lord Kamall (Con)
My Lords, I thank all noble Lords who have spoken on this group. I will speak to Amendment 66 in my name and that of my noble friend Lord Howe. One of the motivations when we were considering amendments from our Benches was not only to respond to concerns raised by stakeholders but to probe the Government on why they did not accept some of the recommendations of the pre-legislative Joint Committee. That is the nature of these amendments. To the noble Baroness, Lady Fox, I say that the amendment is meant as a probing amendment to ask the Government why they have not adopted all the recommendations of the Joint Committee.
One of the things that drives many of us—I feel particularly strongly about this, given my background—is why so many people of an Afro-Caribbean background are being detained or are subject to CTOs. The noble Baroness, Lady Parminter, made a valuable point. One of the reasons I have tabled other amendments along those lines, which will be discussed in later groups, is that, after all these years of saying that too many people from the black community are being detained, if we want to do something about it, we need data, and we need to understand why they are being detained. Without the data, it is left to rumour or speculation, or people make up reasons. Everything needs to be driven by the data if we are to address the fact that a disproportionate number of black people are detained.
We tabled Amendment 66 because the pre-legislative committee recommended that community treatment orders be abolished for Part II patients, those not in the criminal justice system, and wanted a statutory process and timeline to be put in place for the review and potential abolition—I say those words from the Joint Committee’s recommendation very carefully—for Part III patients, those involved with the criminal justice system.
Many noble Lords came to the Second Reading debate wanting to see an end to community treatment orders, and many noble Lords have spoken tonight about this. We were all struck by the words of the noble Baroness, Lady Parminter, and of the noble Baroness, Lady Barker, who very honestly said that, having listened to patients and families, she knows that there is a small group of people for whom CTOs work, are the least restrictive option and are beneficial, and we should therefore keep them. I was particularly struck by that. The noble Baroness, Lady Fox, said that people do not change their mind very often, but the views that we brought to the debate in the first place have been challenged.
The noble Baroness, Lady Barker, made the important point that, while she is reluctant to admit it, she believes that there should be a change in the process around CTOs. That is important. This is why this probing amendment is asking for a comprehensive review of CTOs. We have listed a number of criteria that should be in that review, but I know that many noble Lords have concerns over CTOs.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, I am most grateful to noble Lords for their contributions in this important and interesting area. There have been, and to some degree still are, many different opinions across the Committee. This has been one of those rare occasions when parliamentarians may say that they have changed their minds having listened to the debate and looked into things further; that has added to the richness of what we have before us.
Amendment 43 tabled by the noble Baroness, Lady Browning, would require clinicians to ensure that patients had access to a local prescribing psychiatrist when deciding on a community treatment order. I heard the noble Baroness’s comments about the word “local”; I appreciate her drawing the attention of the Committee to that. I particularly heard the support given by the noble Baroness, Lady Parminter.
In the Bill, to put someone on a community treatment order, it must be necessary for the patient to receive medical treatment, which can be provided without detention in a hospital. I think I heard the noble Baroness, Lady Fox, say—I hope she will forgive me for not quoting her directly—that we should not demonise hospitals. She is nodding; I thank her for that. I can assure her that there is no intention to do that; it is about getting a better balance in the interests of getting the right care for individuals. The responsible clinician must consider whether appropriate medical treatment is available. That would, by necessary implication, include access to a local prescribing psychiatrist if it is what the patient needed.
For a CTO to be made, our reforms also require a community clinician with oversight of the patient’s treatment in the community to agree. The Bill therefore already means that, when deciding whether a CTO is appropriate, access to a prescribing psychiatrist will be fully and properly considered if access to medication is required.
I recall that the noble Baroness, Lady Browning, raised an important point about the shortage of prescribing psychiatrists in some areas and the impact that this could have. We intend that the measures in the Bill in relation to dynamic support registers will improve the monitoring of the needs of, and support for, people who may be at risk of going into crisis and being detained under the Act. ICBs and local authorities will be required to have regard to information on the register when exercising their commissioning and—we have discussed this before—market-shaping functions respectively.
I mentioned earlier the requirements in respect of learning disability and autism training, and autism training for psychiatrists. I hope that will help to reassure the noble Baroness.
Amendment 44, tabled by the noble Lord, Lord Scriven, and spoken to by a number of noble Lords, including the noble Baronesses, Lady Berridge, Lady Parminter and Lady Fox, and the noble Lord, Lord Kamall, relates to the review into the extension of CTOs. I completely understand why the noble Lord was inspired to come forward with this, having been inspired, as the noble Lord and the noble Baroness, Lady Berridge, said, by the words of the noble Baroness, Lady Parminter, at Second Reading and the way in which she relayed her personal experience. That kind of contribution and the impact that it has is exactly what we welcome, and I am glad she is pleased that people listened— indeed we did.
The amendment would ensure that CTOs aligned with the statement of principles in the code of practice and could be extended beyond 12 months only under certain conditions, with a review of the ongoing necessity and the therapeutic benefit of the CTO. I strongly agree with the intention behind the noble Lord’s amendment but it is fully supported by existing provisions in the Bill. Alignment with the code and the four principles is already achieved by new Section 118(2D), which requires clinicians before placing someone on a CTO to have regard to the statement of principles in the code. Under Clause 6, the patient can be put on a CTO only if there is a reasonable prospect of it having therapeutic benefit for the patient, and the Bill will mean that a responsible clinician cannot extend a CTO beyond six months unless the conditions, including therapeutic benefit, continue to be met.
The current code of practice states that, before renewal, the responsible clinician should consult the multidisciplinary team, the patient, the nearest relative—or, in future, the nominated person—and an advocate. The Bill adds that the patient’s community clinician must be consulted before renewal. We are therefore increasing the frequency of automatic referrals to the tribunal to ensure that patients can come off CTOs when they are no longer benefiting. Under the new system, a CTO cannot be extended past the 12-month point without a referral to the tribunal. In the current system, the patient can go for three years before a further referral is required.
Lord Scriven (LD)
That is pleasing to hear from the Minister. So what would stop that going in the Bill?
Baroness Merron (Lab)
As we have discussed before, it is about ensuring that we are able to update in line with good practice, and that can be nimbly—if I may use that word—outlined if it is not in the Bill. We are trying to future-proof it, as the noble Lord is aware, and to ensure that our reviews of our practice and so on are continually updated. That is how I would put it to the noble Lord.
Baroness Barker (LD)
Would the Minister reflect on this? CTOs were brought in under the 2007 Act. The then Labour Government went shopping around the world for various different models of CTOs and cherry-picked bits and pieces out of the ones that they liked to come up with the model that they did. CTOs were brought before the House, and we were assured that they would be used sparingly and we would not run into all the problems that people then foresaw about them being used disproportionately against some minoritised communities.
This is the first opportunity we have had to go back to CTOs. In the 20 years since, absolutely nothing has changed in practice. Twenty years on, there is no indication—even though there must be ample evidence, not just in this country but around the world—about how they work in practice and the fact that they have not worked in the way they were meant to when they were introduced. Does the Minister understand why those of us who have been here so often before are reluctant to accept the argument that is trotted out time after time, that Governments need to be flexible and make change, when within 20 years there has been no change in the face of overwhelming evidence that the law is not working in the way that was intended?
Baroness Merron (Lab)
I can understand the frustration that the noble Baroness outlines. It is hard for me to comment on a number of those 20 years. My feeling is that that is why we are here today updating the Bill. Indeed, at the risk of repeating myself—I will try not to—I take the point that she is making, yet I feel there is a need, under the updated Bill, which I hope will become an Act, to review the overall impact of the new provisions. I understand that we cannot be on a hope and a wing and a prayer. That is not the intention. We will keep CTOs under review as we implement changes. I certainly want to keep a very close eye on their impact, as I know your Lordships’ House will. I know that noble Lords will not be shy to raise any concerns that they have.
Amendment 66, in the name of the noble Lord, Lord Kamall, and supported by the noble Earl, Lord Howe, would require the use of community treatment orders to be reviewed within two years of the Act being passed. As a number of noble Lords have said, we believe that CTOs can be valuable for certain patients—indeed, as we have referred to, the noble Baroness, Lady Parminter, spoke about their benefit for eating disorder patients, as she did at Second Reading—but reform is needed so that they are used only when appropriate and for the shortest possible time.
The noble Lord, Lord Kamall, made a couple of points, which I am happy to write to him about, about concerns about resources. He asked about the role of mental health nurses—an important point—and the effectiveness of CTOs. I will write further on those points.
Lord Kamall (Con)
If the Minister and the officials look at Amendment 66, they will see it asks four specific questions. It could include more, but I wonder whether we can understand what the Government understand about each of those four things, including the impact of community treatment orders on people from different ethnic minorities and the effectiveness of the continued use of community treatment orders. I think it would be interesting for noble Lords to understand what the Government currently understand, if that makes sense.
Baroness Merron (Lab)
Yes, it does. I thank the noble Lord for the clarification. I will come to some of those points, particularly on racial disparity, but I just wanted to ensure that I did not miss the points that he made.
The noble Baroness, Lady Parminter, raised how people with eating disorders will be supported on CTOs. To elaborate a bit on what I said previously, for some people CTOs allow them to be cared for in the community with the least restriction, but with the safeguard that they can be recalled for treatment if necessary. That is a very necessary aspect.
I hope noble Lords are aware that I certainly would agree about the importance of the right data being used to inform decisions, trends and reviews. Data on community treatment orders are published as part of the annual Mental Health Act statistics. My officials are working with NHS England and others to understand what additional data should be collected to understand the impact of the reforms—this relates to the points made by the noble Lord, Lord Kamall.
I know that noble Lords more than understand that gathering new data takes time. Therefore, it is felt that a review after two years would be somewhat premature, as it would be based on data from before the reforms were commenced. So, rather than committing to a review in legislation at a fixed date, the Government are committed to ongoing monitoring of CTOs as we implement the changes. This will form part of our overall commitment to evaluate the impact of reform and to consider next steps. I am sure that your Lordships’ House would wish to continue to be involved in this.
I turn to Amendment 67, tabled by the noble Baroness, Lady Bennett, requiring a review of economic and social disparities in relation to CTOs. I agree, as I have many times, that there are significant disparities in the use of community treatment orders, particularly between different minority ethnic groups. This was spoken to by not just the noble Baroness, Lady Bennett, but the noble Baroness, Lady Berridge, and the noble Lord, Lord Scriven. I will make a few points about this. Those who are black are currently seven times more likely to be detained on a CTO—we have discussed this in your Lordships’ House a number of times, and rightly so, in my view. For CTOs, we are strengthening decision-making in three ways: first, by requiring that an individual must be at risk of serious harm to be made subject to a CTO; secondly, by requiring that the community clinician be involved in all community treatment order decisions; and, thirdly, by increasing the frequency of automatic reviews of patient cases by the tribunal. We will work closely to ensure that the Bill’s provisions are effectively implemented, because a main plank of this legislation is to reduce racial disparities in decision-making under the Act. I am sure we will return to this point many times, and rightly so.
Baroness Bennett of Manor Castle (GP)
I have two questions about data, and I entirely understand if this could perhaps be included in a letter. The racial disparities are well known and well canvassed, but I am wondering about disparities of people living in relatively deprived communities—those that used to be described as “left behind”. There seems to be some evidence of disparity between people in those poorer communities and wealthier communities. Also, on individuals living in poverty versus individuals not living in poverty, what difference is there in CTOs—and more broadly, but CTOs might be a particular area of concern? I am interested in what information the Minister can give—not necessarily now—because we need to focus on that as well.
Baroness Merron (Lab)
The noble Baroness makes a fair point. We will certainly cover CTOs in the planned evaluation of the reforms, including consideration of economic and social disparities. I hope that reassures her.
I turn to the noble Baroness’s Amendment 86. The intended effect given in the explanatory statement provided by the noble Baroness is to retain the requirement for
“an automatic referral to the tribunal when a patient’s Community Treatment Order is revoked”.
The amendment as drafted does not achieve this because it amends a different part of Clause 30—
Baroness Merron (Lab)
Indeed the noble Baroness did try, and I have therefore taken its intention at face value.
The Bill removes the requirement for an automatic referral following the revocation of a CTO. This was a recommendation of the independent review which found that, in practice, the automatic referral was an ineffective safeguard, as often the patient is back in the community or back in hospital as a Section 3 patient before the tribunal has had the opportunity to review their case. Therefore, the current process creates a burden on tribunals but does not protect the patient. The Bill improves other safeguards for patients on a CTO, including increased access to tribunals. For these reasons, I hope that the noble Baroness feels able to withdraw her amendment.
Baroness Browning (Con)
My Lords, I am grateful to everybody who has contributed on this group of amendments. Everybody has bought something different to the table. There have been some good things. I think we are all grateful to the noble Baroness, Lady Parminter, who led us at Second Reading to have a better understanding of how CTOs can help with eating disorders. I just think back to 2006 and the pre-legislative scrutiny committee of the previous amendment of the 1983 Act. I think there are three of us in the Chamber tonight who were part of that pre-legislative scrutiny. I think that the noble Baronesses, Lady Murphy and Lady Barker, and I were members and I recall the debate on community treatment orders at that time, 20 years ago, when we had quite a lot of strong reservations about how they would work in practice.
Despite some of the good things we heard tonight on this group, I still sense that reservation. I think that if what we had before us was 20 years of lived experience—practical examples of where CTOs have been good, where they have been bad, where they needed to be amended and where they have been amended—we would feel a lot more confident. Too many parts of this jigsaw still seem to be missing to make what I feel is a substantial change to the 1983 Act 20 years later and know that we have got it right. I always think that when we are in doubt about legislation, there is that old, hackneyed thing: “Suppose this was something in a court. What would they say about this? What was Parliament’s intention at the time?” Can I actually define Parliament’s intention at the time? I am not sure that I can define it in as much detail as I would like, in order to feel we are doing the right thing as far as this legislation is concerned.
I thank the Minister. She has, as always, been as helpful and courteous as she can be with this very difficult issue, but I do not quite feel that we have got there yet. I beg leave to withdraw the amendment.
Baroness Barker
“(c) after subsection (6) insert—“(6A) Any person subject to a community treatment order must be informed orally and in writing at the time of the making of the order of their right to an independent mental health advocate under section 130A of this Act.””Member’s explanatory statement
The amendment would ensure that people who are to be subject to a CTO would receive information about their right to advocacy.
Baroness Barker (LD)
My Lords, I do not want to bore people who were not present 20 years ago when we were discussing the introduction of this measure, but the main focus of our discussion was that CTOs would be a means of enabling people with serious and enduring conditions, such as schizophrenia, to be compelled to take medication in the community. That was as a matter of public safety and protection for those people. Twenty years on, we are talking about people with eating disorders: it is completely different.
The noble Baroness, Lady Browning, is right: the evidence base behind the discussion is woefully lacking. What we do not know—we do not have the evidence for it—is what change has come about on the part of clinicians. It was sold to us that we were going to stop people being held inappropriately in acute services where they did not need to be and where there was not going to be any therapeutic benefit for them. We have never, to the best of my knowledge, seen that there has been change, nor, indeed, that there has been a flow of resources that has enabled those patients who have been on CTOs to leave acute hospitals and not go back. Unless and until we get that evidence base, frankly, we can all come up with our theories about what are the causal factors, but they are nothing more than our own prejudices and theories.
That said, my amendment on CTOs comes from real-life, front-line experience. As the noble Lord, Lord Kamall, read out from the briefing, there are people whose experience of being on CTOs has been so bad that they want to see an end to them; they do not want to see other people being subjected to them, and I have a degree of sympathy with that. Having said that, I accept that there are some people for whom they work.
Baroness Murphy (CB)
I will speak to Amendment 100 in this group, and there are four or five consequential amendments which I have added. Noble Lords will therefore be pleased to know that the group is a lot smaller than it looks.
The purpose of this amendment is, on the face of it, to remove informal patients from qualifying for help from independent mental health advocates, on the basis that, given the resources required, to expand the services for detained patients to all in-patients is impractical, as in the impact assessment done by the Government. There will be some who assume from this amendment that I do not like IMHAs, but nothing could be further from the truth.
On the face of it, one cannot criticise what appears to be an extension of services and automatic referral to IMHA services, for both detained and informal patients. Local authorities, under direction from Schedule 3, will be obliged to provide the service and will need to extend it significantly. There are currently 50,000 new detained patients eligible for the service every year, but this would double to 100,000 people when informal patients are included. The impact assessment for cost to local authorities calculated that these new services will be an extra £571 million over a 20-year period—that is over half a billion pounds, or £81 million or so every year.
One might assume, therefore, that some serious evaluative research had demonstrated what a boon advocates are, as we all hope so, and that patients valued them and that they made a big difference to their outcomes. However, there is just one small UK study, by Karen Newbigging and her colleagues, which, on quality of services, suggested that where they were accessible— and they were not really very accessible in all the places studied—patients found the process was a positive experience, although they had no impact on outcomes of care and treatment. The advocates concentrated on explaining people’s rights but did not advocate more creatively to change decisions on care, which the authors rightly suggested could be an important role.
It is generally thought that, where IMHAs are from the same ethnic community as the patient, this is one step that could be taken to make the service more friendly for black and other ethnic-minority patients. There is better evidence in the States, where it has been demonstrated that independent advocates are central to the success of advance choice documents; patients do not create advance choice documents without a facilitator. A study in North Carolina showed that providing a facilitator in the form of an independent advocate increased the number of people making a psychiatric advance directive from 3% to 60%. Since we hope that these will be increasingly helpful to patients, I can understand why we think it is very important that detained patients should have them.
However, I would suggest that it is a bit of a leap to go for a massive expansion without much more evidence on how best to use these trained advocates and on who benefits the most. In September 2023, there were 28,600 vacancies—19% of the total workforce—in mental health services, including 1,700 medical and 13,300 nursing vacancies. In spite of training more staff, there is ample evidence that the current challenges posed by in-patient environments mean that many services rely on agency and bank staff simply to keep the ward open. The King’s Fund survey of approved mental health professionals found that, to meet the requirements of a 24-hour service, there would need to be a 30% increase in the number of full-time equivalent staff, in addition to accounting for the vacancy rates of over 11%.
Yet here we are proposing that the local authority should spend a huge amount of money on independent mental health advocates, when it does not have a satisfactory number of psychiatric social workers and cannot fulfil its obligations to provide decent social care for older people or protect vulnerable children from harm. If any noble Lords were reviewing their own local authority spending, do we seriously think that expanding IMHA services to informal patients would be high on the agenda? I think probably not, although I believe they will be helpful, especially for patients matched to someone of the same ethnic background. I would like to see more consistent evidence about how best to recruit and train them and develop their skills because it is crucial, if we do fund them, that we get the basics right, so that when they do get appointed, they are doing the right things for the right people. Otherwise, we should be extremely cautious in expanding these services.
Baroness Tyler of Enfield (LD)
My Lords, I rise to speak to Amendments 102, 105 and 106 in my name. These amendments all deal with extending the provision of advocacy services to informal patients below the age of 18. When I read the other amendments in this group, I thought, “Goodness me, this is going to be a bit tricky, isn’t it?”. It felt at one point as if we were diametrically opposed, and that is not a comfortable position to be in against someone with years of expertise who is as distinguished as the noble Baroness, Lady Murphy. However, I have listened carefully to what she has to say and the nub of it is her concern about resources. On that point, I fully get it, about the workforce generally and advocates in particular. I am going to press on with my amendments none the less, because I am trying to deal with the principle as opposed to the resources.
Both the Independent Review of the Mental Health Act and the Joint Committee on the draft Bill recommended that advocacy should be extended to informal patients. Currently, only those detained under the Mental Health Act 1983 have a legal right to advocacy services. The Mental Health Bill introduces a new opt-out scheme, meaning that all detained patients will get an automatic referral to advocacy services. The Bill also extends advocacy to informal patients, but they will not be captured by the new opt-out scheme, meaning that informal patients will still be required to ask for support via an advocate. This is at the very nub of the problem with which I am concerned.
It is crucial that children and young people aged under 18 admitted to mental health in-patient care informally should have an automatic referral to advocacy services, in line with those who are detained under the Act. There may not be very large numbers—that is relevant to the resource concerns—but it is worth remembering that a higher proportion of children and young people are admitted to mental health hospitals informally. Indeed, it is estimated that around 31% of under-18s are admitted to in-patient care this way—namely, on the basis of their own or parental consent. Having access to an advocate automatically will help young informal patients understand and exercise their rights and ensure they have a say in the decisions made about their care and treatment. This could also lead to improved outcomes and prevent young people being kept in hospital for any longer than they need to be—something I am sure we all agree on.
It is worth adding that the lack of access to advocacy for informal patients has been a long-standing concern. There is a real concern that children and young people admitted informally will continue to experience problems accessing an advocate under the new system proposed as part of the Bill. It has been noted that, often, young informal patients do not understand their rights and feel an underlying threat that, if they break the rules in some way, they will be sectioned. We have to take that into account. Despite the concerns about resources, which I fully understand, access to an advocate is crucial in helping children and young people who are informal patients navigate what is a very complex system.
Baroness Berridge (Con)
My Lords, I will speak briefly to support the amendment tabled by the noble Baroness, Lady Tyler. The extension of advocacy services to children and young people is important, because, as she outlined, there is a disproportionate number of children who are voluntary—I think there are just under 1,000 a year—in mental health institutions.
It is also important to recognise that there are other additional rights that children have when they are detained, or when they have agreed and consented to go into hospital. They need to continue their education while they are in there. It is important to advocate for what their entitlement is while they are in hospital—I think we are all used to walking past the hospital school that is within a normal physical illness hospital—thereby enabling them to continue their education and considering what their rights are in that regard. That is obviously so important for them and their recovery, so I support the amendment from the noble Baroness, Lady Tyler.
Lord Kamall (Con)
My Lords, I have a few brief comments on this group of amendments. In response to Amendment 43A, tabled by the noble Baroness, Lady Barker, given that anyone subject to a CTO already receives something in writing, it should not be too difficult for the Government to accept her amendment. Assuming that they have a right to access independent mental health advocates, it seems like a very reasonable amendment.
Like the noble Baroness, Lady Tyler, I must admit that, when I read the amendments tabled by the noble Baroness, Lady Murphy, I wondered—given that the amendments from the noble Baroness, Lady Tyler, and the noble Lord, Lord Scriven, seek to extend access to independent mental health advocates—why she would want to exclude informal patients from access to those advocates. However, as she explained, and as my noble friend Lady Berridge commented on day one in Committee, we have to deal with the world as it is, not the ideal world that does not exist. As the Minister has often reminded us, this will not all happen in one big bang; the Government’s plan is for it to take over 10 years, subject to spending reviews and resources.
In fact, the noble Baroness, Lady Murphy, made what appear to be two valid points. The first is that we need to be realistic about resourcing. As the impact assessment suggests that expanding access to independent mental health advocates to informal patients will cost £81 million every year, we have to ask: is that the best use of that money, if it were available, given all the other demands on it?
On the noble Baroness’s second observation, I thought that the research cited was interesting: that extending these independent mental health advocates from one environment or cohort of patients to another does not necessarily mean that it will work.
Lord Scriven (LD)
I just wonder where this £81 million per annum comes from. I think that there is a total cost of £99 million over the period, but I am not sure where the £81 million comes from.
Baroness Murphy (CB)
It is taken directly from the Government’s impact assessment on the Bill to local authorities, with these particular resources for IMHAs.
Lord Scriven (LD)
I am reading the impact assessment, and the annual amount is between £6 million to £7 million, and not £81 million. Perhaps the Minister could clarify that when she responds, as the impact assessment that I am reading is different from the £81 million that the noble Baroness, Lady Murphy, and the noble Lord, Lord Kamall, are referring to.
Lord Kamall (Con)
I thank the noble Lord, Lord Scriven, for that, as I would not want to be using inaccurate information. Maybe the Minister can check with her officials, thanks to the wonderful use of technology, to ensure that we have an accurate figure by the time that she gets up to respond to our points. Whichever number is accurate for the cost of extension, it does have an impact on how noble Lords may feel if these amendments come back on Report.
The study that the noble Baroness, Lady Murphy, shared with us contained two statements which I picked up on, and which I hope the noble Baroness will correct if I am wrong. First, patients found the process was a positive experience. But, secondly, the study found no evidence that it had any impact on the outcomes of the care and treatment. That is an important point to make. Once again, what is effective, and what works? Sometimes, feeling better and being more positive is part of a treatment, and we should not dismiss that.
I do not want to sound too negative, as I thought that the North Carolina study was very positive, and the noble Baroness and I corresponded about this over the weekend. It was interesting that it found that black mental health patients benefited from having an independent mental health advocate, especially if the advocate was also black, as patients felt better supported, and more confident that they would be listened to by someone. The crucial point was that it appeared to reduce the rate of repeat detentions. This is one of the crucial issues throughout the Bill. This is one of the reasons why my noble friend Lady May asked for the Wessely review.
Baroness Berridge (Con)
I do not wish to interrupt my noble friend’s flow, but this is one of the key things that is evidence-based, and that does reduce detention for those communities, so it is important.
Lord Kamall (Con)
I am grateful to my noble friend for that intervention, because this is something that we could learn from here. Given the point that the noble Baroness, Lady Murphy, made at the beginning, would taking that lesson from the black community in North Carolina work with black communities up and down the country here? I hope it is something that the Government could look into, or respond to, as one of the ways, once we have the relevant data, to reduce the rate of detention and CTOs for people from the black community.
I end by asking the Minister that question: is she aware of whether her department has looked at—was it North Carolina or South Carolina?
Lord Kamall (Con)
I would not want to upset any people from South Carolina. In fact, I did some work in Raleigh and Durham a few years, so I should get this right. Is the department aware of that study, and has there been any analysis of what could be learned from that study which could be relevant to the United Kingdom, especially given one of the main reasons we are here tonight is to reduce the disproportionate detention of people from black communities? I look forward to the Minister’s responses.
Baroness Merron (Lab)
My Lords, I thank all noble Lords who have spoken to and tabled amendments for this important discussion, which, I am sure my Whip will tell me, will be the last one of the evening.
Baroness Merron (Lab)
I have had that confirmed.
I will first address Amendment 43A, tabled by the noble Baroness, Lady Barker. Patients on CTOs already have the right to independent mental health advocate services. Community treatment order patients will be informed of their right to an independent mental health advocate when they are under Section 3, as part of the opt-out approach for all detained patients, as a patient cannot be placed on a CTO without having been detained first in hospital. They will be aware of this right. In addition, the revised code of practice provides opportunities for further guidance on how to improve the uptake of services for CTO patients, and we will consult on this.
Amendment 102, in the name of the noble Baroness, Lady Tyler, was also spoken to by the noble Baroness, Lady Berridge. We appreciate that advocacy plays a vital role in supporting choice and the person as an individual, and that under-18s are a vulnerable group who would benefit from independent mental health advocate representation. I am pleased to say that the Bill already extends the right to an independent mental health advocate to informal patients, and this includes children and young people. It places a new duty on hospital managers to inform them of this right. As we seek to revise the code of practice, we plan to provide further clarity on how to meet the needs of children and young people, including through this increased access to advocacy, so the point is well made.
I thank the noble Baroness, Lady Murphy, for bringing Amendments 100, 103, 104, 108, 109, 110 and 111 before the Committee today, which were also spoken to by the noble Lord, Lord Kamall. Currently, independent mental health advocacy support is available only to detained patients. We want to extend this support to all in-patients, as we believe it is important for all patients to understand their rights and legal status, not just those who are detained under the Mental Health Act. This is in line with the approach already taken in Wales, where both detained and informal patients are eligible.
The noble Baroness, Lady Murphy, and the noble Lord, Lord Kamall, raised points about expanding advocacy and the use of resources. The figures suggested by the noble Baroness, Lady Murphy, overstate the costs that are set out in the impact assessment. Table 7 in the impact assessment shows that the estimated annual cost of informal advocacy would be between £6 million and £7 million a year. I hope that clarifies things for noble Lords.
Baroness Murphy (CB)
I apologise. Obviously, I was looking at another figure from a different bit of the impact assessment.
Lord Scriven (LD)
I think the noble Baroness, Lady Murphy, added up all the years and got to the final cost, and then described it as an annual cost. I think it was a genuine mistake.
Baroness Merron (Lab)
I am sure that what the noble Lord, Lord Scriven, said is absolutely right—and the noble Baroness has absolutely no need to apologise.
We intend to implement these reforms in phases, when funding and system capacity allow, prioritising an opt-out approach for detained patients. We will expand eligibility for independent mental health advocates to informal patients only when we are sure that doing so will not impact on the resource available to detained patients.
Turning to Amendments 105 and 106, tabled by noble Baroness, Lady Tyler, and supported by the noble Lord, Lord Scriven, as I mentioned, the extension in the Bill of the right to an independent mental health advocate to inform all patients does include children and young people. With regards to an opt-out approach to advocacy, we believe that detained patients have a particular need, given that they are subject to greater restrictions and are potentially more vulnerable compared with informal patients. The Mental Health Act, its code of practice and the regulations relating to the independent mental health advocate services set out that local authorities should ensure that independent mental health advocates understand equality issues and that there are enough independent advocates with a specialised understanding of the specific needs of particular groups—for example, children and young people. As we revise the code of practice, we plan to provide further clarity on how to meet the needs of children and young people, including through this increased access to advocacy. I hope that this reassurance will be welcome.
The noble Lord, Lord Kamall, asked whether the department was aware of the North Carolina or South Carolina study. As we have all agreed, it is in respect of the North Carolina study. We are running culturally appropriate advocacy pilots in Manchester and Birmingham which are testing the approaches to delivering improved culturally competent advocacy services that support specific preferences and needs of people from minority ethnic groups. We have also commissioned an independent evaluation of these pilots and will be looking at that alongside the international evidence that has been discussed this evening. I am most grateful to the noble Lord, Lord Kamall, for raising this.
For all those reasons, I hope that the noble Baroness will withdraw her amendment.
Baroness Barker (LD)
My Lords, I thank the Minister very much. I will not delay the Committee for very long, particularly given the time of night and that people are screaming to go home. However, there are two or three important points that we need to make. First, on community treatment orders, let us remember that it is compulsory treatment in the community. It happens in people’s own homes or wherever they live, but it is compulsory treatment. We are in danger of forgetting that. Secondly, the Minister said that the intention was to ensure that all detained patients have access to an advocate. Advocacy services are in the acute hospitals. They are not out in the community, yet the treatment which is happening in the community is compulsory treatment.
Both of those two points flag up something that a lot of us mentioned at Second Reading. We have taken the 1983 Act and patched it up, and bolted things on and taken things off so many times that we are now at the point of squeezing stuff in and shoving it around, and we no longer have a basic legal framework which is fit for purpose. We are not talking about building seamless community and acute services which people pass through, get better and come out; we are now in Heath Robinson territory. That is why we are in danger of missing some tricks.
The organisations that came up with my amendment are made up of the people who work, day in and day out, to try to build a proper service, as opposed to episodes of care. They are saying that people who are subject to compulsory treatment are not getting advocacy because of the way that the services are set up. I hope that the Minister might take that on board, but at this stage and time of night, I beg leave to withdraw my amendment.