House of Lords

Wednesday 22nd January 2025

(1 day, 2 hours ago)

Lords Chamber
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Wednesday 22 January 2025
15:00
Prayers—read by the Lord Bishop of Manchester.

Political Parties: Donations from Abroad

Wednesday 22nd January 2025

(1 day, 2 hours ago)

Lords Chamber
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Question
15:07
Asked by
Lord Dubs Portrait Lord Dubs
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To ask His Majesty’s Government what plans they have to control or limit donations from abroad to British political parties or pressure groups.

Lord Khan of Burnley Portrait The Parliamentary Under-Secretary of State, Ministry of Housing, Communities and Local Government (Lord Khan of Burnley) (Lab)
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My Lords, as set out on 15 January by my noble friend Lady Taylor of Stevenage, the Government committed in our manifest to protect democracy by strengthening the rules around donations to political parties. Foreign money has no place in our elections and the rules already provide clear safeguards against foreign interference. We are considering changes that will help further protect our system from such risks. Details of these proposals will be brought forward in due course.

Lord Dubs Portrait Lord Dubs (Lab)
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My Lords, the Minister will not be aware, but I wanted to donate to the Democratic campaign on the internet. I could not do so, not because I am living in this country but because I do not have an American passport. I think we have to tighten up our arrangements a bit. Foreign money is undermining our democracy, whether it is donations to particular parties or, more insidiously, to pressure group. There are reports in the papers that an environmental pressure group is going to be funded from the States in order to undermine our attitude to climate change. We need to act quickly.

Lord Khan of Burnley Portrait Lord Khan of Burnley (Lab)
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My Lords, my noble friend makes an excellent point about individuals who are not eligible to vote here. There are rules that govern individuals and organisations that campaign in elections but are not standing in political parties. While it is clear that foreign donations to political parties are not permitted, the Government recognise the risks posed by malign actors who seek to interfere with and undermine our democratic process. My final point is that the rules exist to give the public more confidence in the way third parties interact with the political system. They ensure that campaigning in a transparent manner will prevent any individual, company or organisation exerting undue influence on our elections.

Lord Fowler Portrait Lord Fowler (CB)
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I agree entirely with the noble Lord, Lord Dubs, but is there not a case for a review that goes rather wider than just political contributions from overseas? We have the issue, for example, of whether there should be a cap on all contributions made. Surely, above all, we need a system that is entirely honest and seen as such around the world. Compared with some of the things that are happening now, that would not be a bad example.

Lord Khan of Burnley Portrait Lord Khan of Burnley (Lab)
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My Lords, the noble Lord makes an excellent point. A cap on donations is not a current priority, but strengthening the rules around donations is. By law, it is the responsibility of political parties to take reasonable steps to verify the identity of a donor and whether they are permissible. We will take any necessary steps to ensure that those requirements are tightened and abided by.

Lord Maude of Horsham Portrait Lord Maude of Horsham (Con)
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My Lords, will the Minister give an undertaking that his Government will follow the practice in the latter part of the last Labour Government, where Jack Straw, who had responsibility for these matters, was absolutely meticulous in ensuring that among the major established parties there was consensus on any changes that were undertaken?

Lord Khan of Burnley Portrait Lord Khan of Burnley (Lab)
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Any proposals that we bring forward are likely to require legislation, and although the Government have not included this in the timetable for this Session, we have promised to do it in our manifesto. I can assure all noble Lords that, once we have developed our proposals, we will inform Parliament and consult widely.

Lord Wallace of Saltaire Portrait Lord Wallace of Saltaire (LD)
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My Lords, I am very happy to find that the Conservative Party has rediscovered the idea of consensus now that it is in opposition. I am not sure we want to ban all foreign donations, particularly those from pressure groups and think tanks, but transparency is essential. We need to know who is funding these bodies. Will the Government look again at the need for transparency in reporting where funds come from for all think tanks—left wing, right wing or whatever—that are involved in attempting to influence the political process?

Lord Khan of Burnley Portrait Lord Khan of Burnley (Lab)
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I think it always good to have consensus across the House and in politics. On the noble Lord’s point about transparency, as stated, we are looking at strengthening the rules around donations. To do so, we will look at all the evidence and in due course we will set out our proposals.

Baroness Hayter of Kentish Town Portrait Baroness Hayter of Kentish Town (Lab)
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My Lords, I raised before the issue of permitted donors who live abroad being able to give to political parties. The last Government went ahead with that, despite opposition from this side. Similarly, they brought in ID for voting against our recommendations. I welcome the rather belated view that we should have a negotiation, and perhaps the Opposition would like to say that, this time, they will co-operate this time and not try to do something by themselves.

Lord Khan of Burnley Portrait Lord Khan of Burnley (Lab)
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My noble friend makes an excellent point. She is correct that overseas voters have the right to participate in UK parliamentary elections, and this includes the right to donate to parties or candidates they support. However, foreign money is not permitted, and it is a criminal offence to facilitate an impermissible donation. Those rules apply to voters abroad as well.

Baroness Scott of Bybrook Portrait Baroness Scott of Bybrook (Con)
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My Lords, a Question was asked on this matter on the 15 January 2025, answered by the noble Baroness, Lady Taylor of Stevenage. Can the Minister provide the House with more detail on His Majesty’s Government’s review of all matters relating to electoral donations? In particular, can he confirm that it will address the matter of public bodies disclosing information to political parties, and tell the House when we can expect the review to conclude?

Lord Khan of Burnley Portrait Lord Khan of Burnley (Lab)
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The noble Baroness mentioned a similar Question that was previously asked. When it comes to foreign influence, additional controls are being implemented through the foreign influence registration scheme, which will require those being directed by a foreign power to carry out, or arrange for others to carry out, political influence activities to register with the scheme. I will take her concern forward and ensure that, when we have our wider consultation and bring forward proposals, which are not yet finalised, we will look at this in legislation and policy.

Lord Rogan Portrait Lord Rogan (UUP)
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My Lords, aside from its historic support for terrorism, murder and mayhem, Sinn Féin/IRA is unique in the United Kingdom political system because it receives much of its funding from the Irish Republic and the United States. Over the past five years, Friends of Sinn Féin, the party’s fundraising arm in America, banked more than $2 million. Although laws in the Republic of Ireland prohibit money raised abroad to be sent there, Friends of Sinn Féin can legally send money to Northern Ireland. Can the Minister tell me when His Majesty’s Government intend to close this loophole, which would not be acceptable in any other part of the United Kingdom?

Lord Khan of Burnley Portrait Lord Khan of Burnley
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My Lords, I am sure the noble Lord will understand that I cannot comment on individual cases. I agree with him that political parties registered in Northern Ireland can accept donations from Irish sources, such as Irish companies that meet the conditions. Allowing Irish donations to the Northern Ireland parties recognises the special place of Ireland in the political life and culture of Northern Ireland and is consistent with the principles set out in the Belfast/Good Friday agreement. However, Irish donations are subject to the same scrutiny by the Electoral Commission as donations from any other permissible donor.

Baroness Foster of Aghadrumsee Portrait Baroness Foster of Aghadrumsee (Non-Afl)
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My Lords, last Wednesday, in response to the noble Lord, Lord Blunkett, the noble Baroness, Lady Taylor of Stevenage, said:

“Government take the threat posed by disinformation and foreign actors interfering in our democratic processes very seriously”.—[Official Report, 15/1/25; col. 1123.]


We have already heard from the noble Lord, Lord Rogan, about the amount of money which comes from America into Sinn Féin’s coffers, but that is not the only issue. Its social media accounts are run by a company in Serbia. Will the Minister look at that as well?

Lord Khan of Burnley Portrait Lord Khan of Burnley
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The noble Baroness makes an interesting point. My direct answer would be that we continue to work with the Department for Science, Innovation and Technology and the Defending Democracy Taskforce to mitigate the risk that disinformation and misinformation and AI-driven election interference pose to the UK’s democratic processes. On social media, there are already robust donations and third-party campaigner spending rules in place. The Government remain alert to any technological or other relevant changes in the electoral campaign landscape.

Lord Rennard Portrait Lord Rennard (LD)
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My Lords, for the last 25 years, political parties in this country have been legally obliged to declare the source and scale of all their donations above a very modest level. Why should the same rules not apply to political pressure groups trying to influence the political process?

Lord Khan of Burnley Portrait Lord Khan of Burnley (Lab)
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My Lords, there are already robust spending and donations rules in place for third-party campaigners, which pressure groups would fall under. These are individuals or organisations that campaign in elections while not standing as political parties or candidates. Further rules exist in relation to transparency around those seeking to influence UK policy. The lobbying Act 2014 ensures there is transparency around meetings between Ministers and ministerial groups. The regulation of all-party parliamentary groups is a matter for Parliament.

Railway Electrification

Wednesday 22nd January 2025

(1 day, 2 hours ago)

Lords Chamber
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Question
15:18
Asked by
Lord Faulkner of Worcester Portrait Lord Faulkner of Worcester
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To ask His Majesty’s Government whether they plan to implement a rolling programme of railway electrification, and if so to what timescale.

Lord Faulkner of Worcester Portrait Lord Faulkner of Worcester (Lab)
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My Lords, I beg leave to ask the Question standing in my name on the Order Paper and refer to my railway interests as listed in the register.

Lord Hendy of Richmond Hill Portrait The Minister of State, Department for Transport (Lord Hendy of Richmond Hill) (Lab)
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Updated plans are currently being developed by Network Rail for where and when electrification is required to deliver a fully decarbonised railway over the next 25 years. Those plans will consider the integration of both track and train through Great British Railways and the significant recent progress in battery technology. All investment decisions will be subject to current and future spending reviews and will be for the first time integrated with rolling stock decisions.

Lord Faulkner of Worcester Portrait Lord Faulkner of Worcester (Lab)
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My Lords, at the railway industry reception in the House of Commons last week, my noble friend said—I think I am quoting him correctly—that in the context of Railway 200:

“We’ve got … to celebrate all of the history. But we’ve also got a chance to celebrate the future”.


Does he agree that his Answer to me just now is a way of celebrating that future, provided we can embark on a programme of investment in electrification, battery power and new technologies which allows the railway to grow and the freight business and the passenger business to take on new markets with new traffic? Does he further agree that that is the only way that we can meet the net-zero emission targets and make the railway completely carbon free?

Lord Hendy of Richmond Hill Portrait Lord Hendy of Richmond Hill (Lab)
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Of course, I strongly agree with my noble friend that whatever I said last time was the right thing to say.

None Portrait Noble Lords
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Oh!

Lord Hendy of Richmond Hill Portrait Lord Hendy of Richmond Hill (Lab)
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More seriously, I agree with my noble friend that the point at which we celebrate 200 years of the first public passenger railway in the world is a very good moment both to contemplate the fact that the railway is already uniquely green and to look forward to full decarbonisation. The most exciting prospect has emerged since the last traction decarbonisation strategy of 2020: the significant development of battery technology, the significant introduction of bi-mode trains across Britain and very recently, by one of the most forward-looking freight companies, the introduction of a tri-mode freight locomotive, all of which enables electrification to be far more finely tuned to both cost and value for money yet produce at the end of it a fully decarbonised railway.

Lord Wigley Portrait Lord Wigley (PC)
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My Lords, shortly before the last election, the Conservative Party in its death throes gave a commitment to electrification of the line from Crewe to Holyhead. Do the present Government stand by that commitment?

Lord Hendy of Richmond Hill Portrait Lord Hendy of Richmond Hill (Lab)
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That commitment was one of many in a hurriedly put together document entitled Network North, which incidentally went as far south as Tavistock and went to Holyhead. The characteristic of that shoddy document is that virtually nothing in it was funded, nor indeed was much of it thought through. The last serious work on electrification of the north Wales main line was done by Network Rail in 2010 and that commitment—if it was a commitment—was put in that document with absolutely no reference to any business case nor current set of costs for delivering it.

Lord Anderson of Swansea Portrait Lord Anderson of Swansea (Lab)
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My Lords, some years before their death throes, the last Conservative Government made a firm pledge to electrify the line between Swansea and Cardiff and then, because it was presumably unfunded, like hospitals, they shamefully abandoned it. Can my noble friend confirm that this line is at least now being considered and may well be back on track?

Lord Hendy of Richmond Hill Portrait Lord Hendy of Richmond Hill (Lab)
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My reference earlier to integrating the electrification programme with rolling stock decisions reflects the fact that many trains on the British railway network are now capable of operating in either electric or diesel mode. That is a consequence of rolling stock purchases over the past 10 years. It enables some more choices to be made about the very expensive infrastructure cost of electrification versus electrification where it makes a real difference in both time and volume of rail traffic, and where trains that will run on electricity—when the electricity is there—will also serve parts of the network where it is not.

Some of the decisions which have been taken in rolling stock will last 35 years, like the rolling stock itself. That is true of the Great Western main line electrification, where those trains happily run on the wires as far as Cardiff and then travel by diesel not only to Swansea but further west to Carmarthen and to the south-west as well. A similar situation is true on the Midland main line, where bi-mode trains will be in operation. There is no point in investing in very expensive infrastructure if we can find another way of creating electrification for the vast majority of the network. The study being done by Network Rail, which will be completed and feed in to the department’s overall review of capital projects, will point out where that valuable public money ought to be best spent.

Lord Moylan Portrait Lord Moylan (Con)
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My Lords, the electrification of the north Wales main line, that the Conservative party committed itself to in its manifesto, was to be funded from the savings made from HS2 and the Minister should not say that it was an unfunded commitment.

None Portrait Noble Lords
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Oh!

Lord Moylan Portrait Lord Moylan (Con)
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There is a report out today from Rail Partners which says that the costs of rail freight have been rising three times faster than the costs of carrying freight by road. Part of this is due to the rising cost of electricity. Has the Minister discussed with his colleagues in other departments the effect on the economic case for electrification of their pursuing policies that are giving us the highest cost and the most expensive electricity in Europe?

Lord Hendy of Richmond Hill Portrait Lord Hendy of Richmond Hill (Lab)
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I will continue to claim that the Network North plan was unfunded, because it depended on money that had never been properly allocated in the future to HS2 phase 2. When this Government took office, there was no evidence of any financial plans to deliver virtually any part of that agenda. In respect of the cost of electricity, of course, it is dependent on the relative price of electricity compared with other forms of propulsion for rail, but in terms of electrification of the railway and its use for freight, other considerations are far stronger than the cost of electricity and where it is generated. I shall concentrate in answering this Question on the electrification of the railway, because that is the Question that was asked.

Baroness Pidgeon Portrait Baroness Pidgeon (LD)
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My Lords, rail services in the south-west are just not fit for purpose. A report last week recommended battery power for parts of the route on existing trains, recharging at new electric islands, to help transform the Exeter line for both passengers and freight. As the Government are about to take ownership of South Western Railway, will the Minister consider those proposals?

Lord Hendy of Richmond Hill Portrait Lord Hendy of Richmond Hill (Lab)
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I thank the noble Baroness for her question. The future of the service from Salisbury to Exeter on South Western Railway, which she refers to, is dependent on the fairly imminent life expiry of the existing rolling stock. We will consider, as part of the future of the publicly owned railway, what we do to replace it, bearing in mind that what is now available to replace that rolling stock is far more amenable to discontinuous electrification and battery or other forms of recharging.

Baroness Deech Portrait Baroness Deech (CB)
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My Lords, on the topic of celebration and timescale, does the Minister agree that in Oxford there is no celebration and no timescale? Oxford has been devastated and cut in half. When the Minister comes to Oxford on Friday to see the devastation, why will he not meet the people of Oxford rather than confine his meeting to a few selected, invited people?

Lord Hendy of Richmond Hill Portrait Lord Hendy of Richmond Hill (Lab)
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The noble Baroness refers to the Botley Road bridge in Oxford, which has taken far longer to replace than it should and is a complex story. I am going to Oxford on Friday. The logistics of meeting people in Oxford are such that it necessarily has to be limited by the time available to do it, but I am very mindful of the case that she has made both this afternoon and earlier about the disruption caused by this bridge, which is partially caused by the development of East West Rail in Oxford. Together with the chief executive of Network Rail, we have some things to say to the population which I hope will be useful for them to hear.

Lord Snape Portrait Lord Snape (Lab)
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My Lords, does the Minister recollect that more than 40 years ago, Sir Peter Parker, the then chairman of British Rail, recommended a rolling programme of railway electrification on the grounds that it would assist to keep together those responsible for doing the work and, perhaps more importantly, be far cheaper in the long run than the piecemeal approach that we have adopted over the years since? As we have a long-term plan for road building and repairs, why cannot we have the same for the railway?

Lord Hendy of Richmond Hill Portrait Lord Hendy of Richmond Hill (Lab)
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My noble friend raises a very good point. The intention of both the Secretary of State and me in respect of the review of capital projects in the department is to produce a list of projects which are the best for economic growth, jobs and housing, and then that can go into the Government’s 10-year infrastructure plan. It is important that the supply industry that develops electrification has a strong domestic market, because there is also a strong export market which it can fully serve only if domestic demand is relatively constant.

Small Modular Nuclear Reactors

Wednesday 22nd January 2025

(1 day, 2 hours ago)

Lords Chamber
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Question
15:29
Asked by
Lord Spellar Portrait Lord Spellar
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To ask His Majesty’s Government when they expect to announce the orders for the first small modular nuclear reactors.

Lord Hunt of Kings Heath Portrait The Minister of State, Department for Energy Security and Net Zero (Lord Hunt of Kings Heath) (Lab)
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My Lords, Great British Nuclear is pushing forward with the SMR competition and is negotiating with a four down-selected companies. Once negotiations have concluded, the companies will be invited to submit final tenders, which Great British Nuclear will then evaluate, with final decisions to be taken in the spring.

Lord Spellar Portrait Lord Spellar (Lab)
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I thank the Minister for that Answer. He will be aware that the Government’s response to the AI action plan this month refers to the opportunity

“to accelerate investment in … Small Modular Reactors”.

He will also be aware that Britain is at the forefront of developing this technology, which could make a significant contribution to our growth agenda right through the country. However, delays in decision-making by the last Government led to significant slippage in the programme. What is the Minister’s department doing? He gave the procedure that would be undertaken, but what is the department doing to get the SMR programme back on track?

Lord Hunt of Kings Heath Portrait Lord Hunt of Kings Heath (Lab)
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My Lords, I understand my noble friend’s impatience. It is an impatience that I share, because we can all see the potential of small modular reactors in the UK and the export potential of UK companies that are involved in developing SMRs. With fairness to Great British Nuclear, it is going through a tough process. We will have assurance with regard to the technologies and value-for-money issues. Spring is not far away. I understand the haste with which my noble friend wishes us to act in this area.

Lord Deben Portrait Lord Deben (Con)
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My Lords, the French Government have given this Government a great opportunity to stop any further growth of Sizewell C and use that money for small modular nuclear reactors. This is an out-of-date proposal. It will cost much more than we bargained for. It is a brave and sensible Government who would say, “We will stop that and move to new technology”.

Lord Hunt of Kings Heath Portrait Lord Hunt of Kings Heath (Lab)
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My Lords, if a Government were suddenly to say to Sizewell C, “We’re not going ahead with it”, that would have a devastating impact on our nuclear industry. We are not going to do that. We are moving towards a final investment decision. I do not recognise some of the figures that have been quoted in the media recently. It is 80% replication of Hinkley Point C, but because of that, a lot of the risks have already been ironed out.

Lord Birt Portrait Lord Birt (CB)
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My Lords, I am attracted in principle to the idea of small-scale nuclear reactors scattered across the country on small sites and not just in nuclear submarines. But I have attended a number of meetings with the industry and have no clarity on the economics of the technology and how they compare with alternative paths to net zero. Does the Minister think that the economics are clear yet? If not, will the Government set them out?

Lord Hunt of Kings Heath Portrait Lord Hunt of Kings Heath (Lab)
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My Lords, there are two points to make. Our analysis is that, overall, a renewable-led system complemented by flexible technologies, alongside technologies such as nuclear, will form the cheapest foundation for our decarbonised power grid. The value for money for SMRs is a very good question. That is precisely why the work that Great British Nuclear is doing will be so important and why it then has to feed into more general discussions within government about the finance involved.

Earl Russell Portrait Earl Russell (LD)
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My Lords, as the SMR contracts have been delayed, has the proposed twentyfold increase in AI been included in the clean power plan? What are the Government’s proposals to deliver the energy required and meet our energy net-zero targets if SMRs will not be ready before 2032?

Lord Hunt of Kings Heath Portrait Lord Hunt of Kings Heath (Lab)
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My Lords, obviously, we are all very excited by the potential of AI. My understanding is that current electricity demand from, for example, data centre growth—which is part of the package that the noble Earl is referring to—would in 2022 account for 4.05% of UK electricity consumption. NESO’s analysis of future energy scenarios reckons that data centres could increase annual electricity demand by between 27 and 62 terawatt hours by 2050, with estimates of total annual electricity demand ranging from 533 to 700 terawatts hours. Obviously, we are giving this a great deal of consideration.

Lord Harris of Haringey Portrait Lord Harris of Haringey (Lab)
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My Lords, I refer to my interests in the register. Existing civil nuclear power stations are protected by the Civil Nuclear Constabulary, which is, of course, wholly armed. What consideration has been given to who will protect and police modular nuclear reactors? Will it be the Civil Nuclear Constabulary, which would mean covering far more sites than it currently does, or will it be the other police forces? What discussions has the Minister had with his colleagues at the Home Office?

Lord Hunt of Kings Heath Portrait Lord Hunt of Kings Heath (Lab)
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My Lords, it is a little early to give a definitive view to my noble friend but clearly the role of the Civil Nuclear Constabulary is a very important one. I reassure him that in the 14-year gap since I was last responsible for that force, there have been huge improvements in the way in which the constabulary works. I keep this matter under very close oversight.

Baroness Bloomfield of Hinton Waldrist Portrait Baroness Bloomfield of Hinton Waldrist (Con)
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My Lords, it is welcome news that the Minister has indicated there will be a decision by Great British Nuclear on SMR technologies in the spring. However, we still await any guidance on advanced modular reactors, let alone details on how they can come to the market and generate much-needed clean energy here in the UK from the early 2030s. A number of privately funded developers—newcleo, X-energy, TerraPower and others—are ready to go and want GBN to have a parallel process alongside the SMR competition to help them realise their ambitions in the UK as soon as possible. Will the Minister please give a clear indication on when a plan for AMRs will be published? Will His Majesty’s Government support those that want to get on with things in the meantime, invest in the UK, boost economic growth, and create thousands of jobs through their supply chains?

Lord Hunt of Kings Heath Portrait Lord Hunt of Kings Heath (Lab)
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My Lords, I am grateful to the noble Baroness for her questions and we certainly take account of what she said. We all see the potential of AMRs. We have also seen that some of the major west coast companies in the US are interested in reaching agreements with project developers for AMRs to be sited near data centres in order to produce decarbonised energy. The noble Baroness’s Government produced an alternative routes to market consultation. We are currently considering the results of that and will make announcements in due course. I understand what she said about the role of GBN. These matters are all under earnest consideration at the moment.

Lord Tarassenko Portrait Lord Tarassenko (CB)
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My Lords, the noble Lord, Lord Spellar, mentioned the AI opportunities action plan, including the plan to build data centres—among them, the largest UK data centre so far. These data centres, which have been designated by the Government as sovereign data centres, will require SMRs to power them. Rolls-Royce, in which the Government hold a golden share, has produced and maintained the nuclear power systems for the UK’s submarine fleet using similar —not the same but similar—technology for SMRs for the last 60 years. Will the Minister ask the Science Secretary and the Energy Secretary, who together will chair the AI energy council, to designate the SMRs that will supply the sovereign data centres, also as sovereign assets, and run a much shorter bidding process open to UK companies only?

Lord Hunt of Kings Heath Portrait Lord Hunt of Kings Heath (Lab)
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My Lords, I do not think I can give that commitment, although I recognise what the noble Lord says. I can certainly assure him that we are in close discussions across government departments about taking forward the implications of what was contained in the plan. I, of course, recognise the role that Rolls-Royce plays. I do not want to say anything further about that because it is currently in a competitive process in relation to SMRs that is being run by Great British Nuclear.

Baroness Winterton of Doncaster Portrait Baroness Winterton of Doncaster (Lab)
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My Lords, is my noble friend the Minister aware that the proposal by a consortium of Sheffield industrialists for an SMR national manufacturing centre of excellence would create hundreds of highly skilled jobs in South Yorkshire and across the country, and would also open up the opportunity for British industry to compete internationally for the manufacture of SMRs with British components? Can he assure me that this is exactly the sort of proposal his department will consider supporting and is in line with the points made by my noble friend Lord Spellar?

Lord Hunt of Kings Heath Portrait Lord Hunt of Kings Heath (Lab)
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My Lords, the noble Baroness may know that I met our former colleague Richard Caborn and colleagues from Sheffield to discuss this. We have now asked UK Research and Innovation to review the detail and advise us. We will then consider the next steps. Clearly, this is a very interesting concept.

Israel and Palestine

Wednesday 22nd January 2025

(1 day, 2 hours ago)

Lords Chamber
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Question
15:39
Asked by
Baroness Ritchie of Downpatrick Portrait Baroness Ritchie of Downpatrick
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To ask His Majesty’s Government what discussions they have had with international partners about establishing a fund to support infrastructure in Gaza and reconciliation between Israel and Palestine.

Lord Collins of Highbury Portrait The Parliamentary Under-Secretary of State, Foreign, Commonwealth and Development Office (Lord Collins of Highbury) (Lab)
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My Lords, this deal is a fragile process but one that the United Kingdom is ready to support. It is a first step. We must build confidence on all sides to help sustain the ceasefire, moving it from phase 1 through to phase 3, into a political process that sees lasting peace. We are already convening partners to build consensus for a post-conflict Gaza governance and security framework, and co-ordinated and effective support for recovery and reconstruction.

Baroness Ritchie of Downpatrick Portrait Baroness Ritchie of Downpatrick (Lab)
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I thank my noble friend Minister for his Answer. Would he agree, as has been the case in other areas of conflict, that a vibrant, free and civil society is essential to building peace and reconciliation? In this respect, would it be possible for the Government to increase their funding to human rights groups in Palestine and Israel to underpin the organic growth of that much-needed civil society to try to achieve a shared future and reconciliation for all citizens of Israel and Gaza?

Lord Collins of Highbury Portrait Lord Collins of Highbury (Lab)
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Through our aid programmes, we are supporting human rights organisations in Israel and Palestine on a range of issues. Their work is invaluable for providing us with relevant analysis, as well as for shaping our policy. We are clear that Palestinian leadership and civil society must be at the forefront of Gaza’s recovery. The United Kingdom is committed to promoting an inclusive approach to recovery and reconstruction, supporting the political process towards a two-state solution.

Lord Callanan Portrait Lord Callanan (Con)
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My Lords, I am sure we are all delighted to see the ceasefire and the release of the three hostages, including the British national Emily Damari, earlier this week. I listened carefully to the Minister, and he is right that proper future governance in Gaza will be crucial if the current ceasefire is to be enduring. Perhaps he could say a bit more about what consideration the Government are giving to helping establish future governance and administration in the Gaza Strip, free, we hope, of the malign influence of Hamas.

Lord Collins of Highbury Portrait Lord Collins of Highbury (Lab)
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I thank the noble Lord for that question. We are continuing to work with Israel, the Palestinian Authority, the US and regional partners to build consensus on a post-conflict Gaza governance and security framework that supports the conditions, as he rightly said, for a permanent and sustainable peace. We have given the PA two posts to help support its work on this, and we will look towards doing even more as we move through the stages of the ceasefire agreement.

Baroness Deech Portrait Baroness Deech (CB)
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My Lords, has the Minister read the wise words of the noble Lord, Lord Finkelstein, in this morning’s Times, where he points out that the time has come for the Palestinians to behave like all the millions or trillions of people displaced since the Second World War with the creation of new states? Does the Minister agree that the problem is UNRWA? The Arabs have to accept the existence of Israel and UNRWA must resettle refugees. It must get them settled in the countries in which they are living and make sure that they have full civil rights, so that their children grow up not to hate but to make a new life and take new opportunities in the countries where they are living, like all other refugees around the world.

Lord Collins of Highbury Portrait Lord Collins of Highbury (Lab)
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I hear what the noble Baroness says, but, of course, many Palestinians are living in occupied territory. We want to ensure, through the peace process that has been agreed, that we work with all sides to bring them towards a consensus that will ensure the safety and security of Israel, as well as the safety and security of a Palestinian state. We must work towards that, and this agreement provides the basis to do so.

Lord Purvis of Tweed Portrait Lord Purvis of Tweed (LD)
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My Lords, the people of Gaza need homes and shelter. The UN estimated last summer that clearing the 40 million tonnes of rubble in Gaza will take 15 years. Does the Minister agree that human reconstruction, especially for the children of Gaza—who are equivalent to the entire under-10 population of London and are homeless, without shelter or health or education facilities—should be our number one mission? The UK cannot do everything for the reconstruction, but it can ensure that some pop-up education and child trauma centres are erected now, so that if there is any kind of sustainable peace it ensures that children are at the heart of any kind of reconstruction and recovery.

Lord Collins of Highbury Portrait Lord Collins of Highbury (Lab)
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I agree completely with the noble Lord. In fact, we have announced £112 million this financial year, including £41 million for UNRWA, which is supporting the Occupied Palestinian Territories and Palestinian refugees in the region. This support has meant that half a million people have received essential healthcare funding and medical support. More than 300,000 people have been treated. The noble Lord is also right to focus on children. Some 14,000 children now have access to education materials and welfare support because of UK intervention. However, this is only the beginning. It is a huge process that we must commit to, but if we can work with our partners across the globe, we can do that.

Baroness Blower Portrait Baroness Blower (Lab)
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My Lords, I commend the work that His Majesty’s Government are doing in seeking reconciliation and reconstruction in Gaza. Given that there might now be the possibility of temporary urgent medical evacuation, in particular for children who are in the most serious situations, will the Government consider bringing some children to the UK on the clear understanding that they will return to their homes in Gaza, whether those are temporary or, ultimately, permanent?

Lord Collins of Highbury Portrait Lord Collins of Highbury (Lab)
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It is vital that Israel ensures that there is sustained passage for patients who need treatment that is not available in Gaza during the first phase of this ceasefire. That means working with neighbours, because speed and distance are important factors in receiving treatment. However, I reassure my noble friend that officials across Whitehall are looking at all options to make sure that we are doing everything in our power to help and to explore all avenues to support those who are critically ill in Gaza. That is why we have also announced £1 million for the Egyptian Ministry of Health and Population, delivered through WHO Egypt, to support Palestinians who are medically evacuated from Gaza.

Baroness Altmann Portrait Baroness Altmann (Non-Afl)
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My Lords, does the Minister agree that Israel has, for its entire existence, sought a two-state solution and to live in peace alongside a Palestinian state? Unless and until the Palestinians themselves accept Israel’s very right to exist and stop indoctrinating their children that the only thing that matters is recovering, “from the river to the sea”, the land that they have claimed ownership of but which has been disputed for so long, it will be very difficult to see a sustainable path to peace for Israelis and Palestinians, especially with the ongoing international involvement in the indoctrination of children via UNRWA schools.

Lord Collins of Highbury Portrait Lord Collins of Highbury (Lab)
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I think noble Lords will appreciate that we have an opportunity to focus on the broader issues when we come to the Statement. The United Kingdom is ready to play a leading role with international and regional partners in the process towards that next stage of the two-state solution. It is predicated on tangible progress towards a Palestinian state, with Gaza and the West Bank united under one Government. The PA’s role in Gaza must therefore be front and centre. Planning needs to advance security for both Gazans and Israel, as the noble Baroness pointed out.

Baroness Hayman Portrait Baroness Hayman (CB)
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The Prime Minister’s support and leadership on setting up an international fund for Israeli-Palestinian peace has been welcomed by those involved in civil society peacebuilding, brought together by the Alliance for Middle East Peace. There was talk of a conference to launch this fund in this country early in the new year. Can the Minister give us any details on when that conference might take place?

Lord Collins of Highbury Portrait Lord Collins of Highbury (Lab)
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Sadly, I am not able to give details at this stage, but since the ceasefire agreement we have been assessing how we can build that stronger alliance across allies and, in particular, the Gulf states to ensure that we can focus on the issues. When I get more information, I will write to the noble Baroness.

Public Service (Ethics, Integrity and Independence) Bill [HL]

Wednesday 22nd January 2025

(1 day, 2 hours ago)

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First Reading
15:51
A Bill to make provision about mechanisms for promoting and protecting standards of integrity and ethics in the public service; to make provision about appointments to the House of Lords and the House of Lords Appointments Commission; and for connected purposes.
The Bill was introduced by Lord Anderson of Ipswich, read a first time and ordered to be printed.

Electricity Capacity Mechanism (Amendment) Regulations 2024

Wednesday 22nd January 2025

(1 day, 2 hours ago)

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Clean Heat Market Mechanism Regulations 2024
Motions to Approve
15:52
Moved by
Lord Hunt of Kings Heath Portrait Lord Hunt of Kings Heath
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That the draft Regulations laid before the House on 18 and 21 November 2024 be approved.

Relevant document: 10th Report from the Secondary Legislation Scrutiny Committee. Considered in Grand Committee on 20 January.

Motion agreed.

Airports Slot Allocation (Alleviation of Usage Requirements etc.) Regulations 2025

Wednesday 22nd January 2025

(1 day, 2 hours ago)

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Motion to Approve
15:53
Moved by
Lord Hendy of Richmond Hill Portrait Lord Hendy of Richmond Hill
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That the draft Regulations laid before the House on 4 December 2024 be approved.

Relevant document: 12th Report from the Secondary Legislation Scrutiny Committee. Considered in Grand Committee on 20 January.

Lord Trefgarne Portrait Lord Trefgarne (Con)
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My Lords, am I permitted to ask a question?

Lord Gardiner of Kimble Portrait The Senior Deputy Speaker (Lord Gardiner of Kimble)
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My Lords, this instrument has already been debated in Grand Committee.

Motion agreed.

Community Engagement Principles and Extremism Definition

Wednesday 22nd January 2025

(1 day, 2 hours ago)

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Commons Urgent Question
The following Answer to an Urgent Question was given in the House of Commons on Tuesday 21 January.
“National security will always come first for this Government, and we will always treat the threat of extremism with the seriousness that it requires. As the Prime Minister said this morning:
‘Britain now faces a new threat’—
a threat of extreme violence from people who are driven by material online. They are often now lone individuals who are driven by a twisted desire for notoriety. It is a threat that we must contend with, alongside that from traditional terrorist groups.
The House will be aware that the Home Secretary will make a Statement to the House shortly. All aspects of this changing threat will be considered in her rapid review, ordered last year, which will inform the Government’s counter-extremism strategy. The review panel is considering the current understanding of extremism, including Islamist and far-right extremism, and its work will include a focus on how best to tackle the threat posed by extremist ideologies, both online and offline. Early findings were set out in December, alongside initial measures to tackle the challenges that we face. The Home Office will provide a further update on the measures and actions arising from the counter-extremism sprint shortly.
Our department retains responsibility for communities and cohesion policy, and the Deputy Prime Minister has convened a new cross-government communities recovery steering group to develop a comprehensive strategy to address the underlying causes of divisions in our local communities. In particular, it seeks to address some of the causes of the disorder across the UK following the Southport tragedy last summer. We have made it clear that a new approach is urgently needed, and we have backed that with an initial £50 million from the Ministry of Housing, Communities and Local Government community recovery fund to support areas that were impacted over the summer”.
15:54
Lord Jamieson Portrait Lord Jamieson (Con)
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My Lords, does the Minister agree that, in addition to reviewing the definition of extremist organisations and the community engagement strategy, we should also review the wider communication policy regarding acts of extreme violence and terror to maintain an open dialogue with the general public and prevent the spread of misinformation?

Lord Khan of Burnley Portrait The Parliamentary Under-Secretary of State, Ministry of Housing, Communities and Local Government (Lord Khan of Burnley) (Lab)
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My Lords, let me first of all say that national security will always come first for this Government, and we will always treat the threat of extremism with the seriousness that it requires. The noble Lord makes an interesting point. I confirm to the House that the Government take the threat of extremism very seriously and will continue to work with partners to tackle extremism in all parts and forms. That is why the Home Secretary commissioned a rapid review of extremism in 2024. The Government will set out their approach to countering extremism in due course and will update Parliament accordingly. I am sure that many of the issues that the noble Lord raised will be part of that review.

Baroness Pinnock Portrait Baroness Pinnock (LD)
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My Lords, knowledge and understanding of communities is crucial in this regard. Councillors are elected to serve their communities and know them well. Does the Minister agree with that proposition? Does he also agree that plans to create large wards make that more challenging for councillors? Will the Government therefore keep ward sizes appropriate to their role in knowing and representing their communities, and will the Government provide additional support to councillors in that critical role?

Lord Khan of Burnley Portrait Lord Khan of Burnley (Lab)
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My Lords, let me reassure the noble Baroness that, having been a councillor for 16 years in the wonderful district of Burnley, I understand the fantastic work that local councils do. I reaffirm the Deputy Prime Minister’s position that we want to work in equal partnership with the local authorities and we want to give them more power. I would not be able to comment on the size of the wards because that is the responsibility of the Minister, Jim McMahon, in the other place.

Baroness Hazarika Portrait Baroness Hazarika (Lab)
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My Lords, I am sure the whole House will agree that this work could not be more important or timely. As a Muslim woman, can I ask the Minister what has been done to engage with women and girls’ voices? It feels like our voices are often ignored, and certain very noisy male groups dominate the conversation. Will the Minister acknowledge that it is often women and, sadly, girls, who are the victims of extremist violent behaviour?

Lord Khan of Burnley Portrait Lord Khan of Burnley (Lab)
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My Lords, my noble friend makes a series of excellent points. I totally agree about extremist behaviour and its disproportionate impact on women and girls. Let me reassure the noble Baroness that we are looking at ensuring that we have more female voices—not just female voices, but young female voices—in the faith space. Let me also let the House know that I have been up and down the country and have engaged not just with the major faiths but with every faith in our country. That has been a privilege, but I have learned that there need to be more female voices in the faith space.

Lord Bishop of Manchester Portrait The Lord Bishop of Manchester
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My Lords, a decision under the previous Government about a particular Islamic organisation being characterised as extremist led to the defunding and collapse of the national Inter Faith Network. I wonder if the Minister agrees that the Inter Faith Network provided a vital role in co-ordinating interfaith work at a national level. We do great things at local level, but we need some national work as well. Will he urge His Majesty’s Government to commit to refunding the Inter Faith Network?

Lord Khan of Burnley Portrait Lord Khan of Burnley (Lab)
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My Lords, I pay tribute to the right reverend Prelate, with whom I have worked closely in the interfaith area in the north-west of England. I totally agree about the work of the Inter Faith Network. It is important that there is a national forum. Although we will not be bringing back the Inter Faith Network as it was previously, we are looking to ensure that that work is brought back and we are exploring ideas. My department, the MHCLG, has just commissioned some research and a consultation on what form that will take in future, so that there is a national interfaith presence that the Government can regularly engage with.

Lord Robathan Portrait Lord Robathan (Con)
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My Lords, given the changes to the definitions of extremist organisations, can the Minister please reassure me and the House that the Provisional IRA remains defined as a terrorist and extremist organisation? Can he therefore take back to his colleagues in government the real fear that many of us have that members of the Provisional IRA, including Gerry Adams, will be compensated in some way by the British taxpayer?

Lord Khan of Burnley Portrait Lord Khan of Burnley (Lab)
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My Lords, I think it is just for me to say that I will take back the noble Lord’s concerns.

Viscount Brookeborough Portrait Viscount Brookeborough (CB)
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My Lords, will the Minister consider that there are a lot of good lessons to be learned from Northern Ireland on community relations? Those relations have come on a great deal, and that is often about creating neutral spaces and reasons for communities to come together that are not related to being extreme or not getting on. It is about getting people on the fringes of those extremists to enjoy life together for other reasons—and that may be sport or art—on neutral ground. Often, when you target people to bring them together, those people naturally resist being brought together, so it is about doing it from ground level up, and doing it because people want to enjoy doing things together.

Lord Khan of Burnley Portrait Lord Khan of Burnley (Lab)
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My Lords, the noble Lord made some interesting points. On the initial point about community relations, I reassure him that that is very important, and it is why counter-extremism has gone back into the Home Office. In my department, I am the Minister responsible for cohesion. We work with different communities to ensure, up and down the country, we hear those diverse voices, not just faith-based voices but from different communities, different diasporas and different parts of the country. So I reassure the noble Lord that this work is happening and we are working with our partners and across the country.

Lord Harries of Pentregarth Portrait Lord Harries of Pentregarth (CB)
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Did the Minister see the result of a rather disturbing poll the other day that one in five people between the ages of 18 and 45 would rather have a strong leader than democracy? Democracy, of course, is about solving one’s political problems without violence. Does he agree that there is a failure at the moment in our country to encourage people in schools to really understand democracy and believe in it? It is not the only aspect of the matter, but we want children to come out of our schools believing in democracy and in doing these things without violence.

Lord Khan of Burnley Portrait Lord Khan of Burnley (Lab)
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My Lords, the noble and right reverend Lord makes a strong point about ensuring that we provide more education about and awareness of the importance of democracy. Democracy unfortunately is also being attacked by malign actors and foreign interference, as we have seen evidence of in recent weeks and even in previous elections. I reassure the noble and right reverend Lord that I am having those conversations with the Department for Education and the Minister responsible to ensure that we can look at focusing education and getting more understanding of democracy, so our citizens understand and appreciate the historical struggle for democracy and celebrate our system. Although there are challenges, it is a wonderful system and we need to ensure that people engage with it.

Lord Ahmad of Wimbledon Portrait Lord Ahmad of Wimbledon (Con)
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My Lords, just a small point first: countering extremism always has sat in the Home Office. I should know, as I was the first Minister for Countering Extremism in the Home Office. Linked to that, a lot of the extremism is imported from other parts of the world and it is important to stop it at source. Can the Minister assure this House that there will be an integrated approach to ensure that the foreign threat is also dealt with?

Lord Khan of Burnley Portrait Lord Khan of Burnley (Lab)
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My Lords, the noble Lord makes an excellent point about making sure that there is an integrated approach. I do not want to pre-empt the conclusion of the rapid sprint, which the Home Secretary has not completed yet, although there were some initial findings in December. The Deputy Prime Minister has made sure that community cohesion, community relations and working with communities come within MHCLG and the Home Office takes responsibility for counter-extremism. I know that was the situation when the noble Lord was in post, but when I came into post it was not the situation. Clarity has now been found. That work is important and the Home Secretary is leading on it.

Baroness Whitaker Portrait Baroness Whitaker (Lab)
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My Lords, on a point of clarification, because Hansard is a journal of record, will my noble friend the Minister confirm, in answer to the noble Lord, Lord Robathan, that Gerry Adams was never a member of the Provisional IRA—as he would himself say—but was a leader of the IRA which took, of course, a significant part in the Good Friday agreement? He was not in the Provos.

Lord Khan of Burnley Portrait Lord Khan of Burnley (Lab)
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I say to my noble friend that I am not in a position to comment on that. I think it is a conversation that the noble Baroness needs to have with the noble Lord and settle it outside.

Middle East

Wednesday 22nd January 2025

(1 day, 2 hours ago)

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Statement
The following Statement was made in the House of Commons on Thursday 16 January.
“With permission, I will update the House on the deal announced between Israel and Hamas. Last night, US President Biden and Qatari Prime Minister Al Thani confirmed that negotiators had reached an agreement. While we await political approval for the text, the agreement is expected to come into force shortly after midday Israel time on Sunday 19 January.
After months of despair, there is now hope; a glimmer of light in the darkness; a darkness that had seemed all-consuming since Hamas’s barbaric terrorist attack on 7 October 2023. I am sure that the whole House remembers the agony as we learned the full horror of what had unfolded and the grief as we mourned those who were lost. For the hostage families, the agony has gone on and on. Members across the House will have met many of them, including the relatives of British citizen Emily Damari, and Eli Sharabi, Oded Lifschitz and Avinatan Or. I know that we have families with us in the Public Gallery. I pay tribute once again to them for their bravery, humanity and commitment to bringing the hostages home.
I invite the House to join me in remembering those murdered in captivity, including Nadav Popplewell and Yossi Sharabi. May their memories be a blessing.
I say to all those now waiting anxiously to see what this deal means for them: we are with you in the days and weeks ahead. In Gaza today, civilians will be waiting anxiously to see what this deal means for them. I say to them, too: we are with you as you begin to rebuild your lives.
After 15 months of conflict, the level of suffering defies belief. Gazans have truly been trapped in hell on earth—over 46,000 killed, so many children’s lives extinguished, schools, hospitals and homes destroyed, and hunger and disease. Almost 2 million have been forced to flee their homes, with northern Gaza cut off from the rest of the strip. A generation has been scarred by the savagery of war.
Among the victims was Hind Rajab, a five year-old Palestinian girl killed alongside members of her family and the paramedics who came to rescue her. Among the victims were many journalists dedicated to documenting the horrors around them. Among the victims were aid workers dedicated to serving others, including British citizens John Chapman, James Henderson and James Kirby. I invite the House to join me in remembering them all. We mourn every innocent victim of this appalling war.
Beyond Israel and Gaza, the conflict has brought yet more tensions and conflict into the wider region, with unprecedented Iranian attacks, a renewed conflict in Lebanon and Houthi strikes in the Red Sea and into Israel. At times, our own communities—and indeed this House—have been divided by this war. This is a moment of hope for us all, to unite in support of this ceasefire.
The agreement as negotiated has three stages. In the first six-week phase we expect that both parties will stop fighting. Thirty-three of the hostages will be freed: children, women, those over 50 and the wounded. Israel will start to redeploy to the edge of the strip. Palestinians will return to what is left of their homes. The Rafah crossing will reopen. Israel will allow 600 truckloads of aid into Gaza each day. On the 16th day, negotiations will begin on the detail of the second phase. In the second six-week phase, the male hostages under 50 will be released. Israel will complete its withdrawal from Gaza, and there will be a permanent ceasefire. Finally, a third phase will see the return of the bodies of any remaining hostages and the lifting of economic restrictions on Gaza.
As President Biden said, the elements of this deal were endorsed by the United Nations Security Council last May. It has taken tireless efforts to reach the agreement of both sides, with reports of final talks this week lasting an intense 96 hours. I congratulate all those who have contributed to getting to this stage: in particular, His Highness the Emir of Qatar and Prime Minister Al Thani; Egyptian President Sisi and Foreign Minister Abdelatty; and President Biden and Secretary Blinken, as well as President-elect Trump. The UK has been supporting them throughout.
From day one in office, the Government have pressed at every stage for an immediate ceasefire, to free the hostages, to get more aid into Gaza and to open up a path to lasting peace. I visited Israel and the Occupied Palestinian Territories for the third time as Foreign Secretary just a few days ago, meeting Foreign Minister Sa’ar, President Abbas and hostage families, to press for an end to this war and a plan for the future.
We have also played a leading role in the humanitarian effort, restarting funding to the United Nations Relief and Works Agency, funding field hospitals that have treated more than 300,000 Gazans, and providing more than £100 million in support to the Palestinians this financial year. I pay tribute to Foreign Office Ministers in the last Government for their work to deliver aid to Gaza. Now I am in this role, I know how hard they worked. That intense effort must continue in the days and weeks ahead.
Much remains to be done. It is critical that there is final approval of the agreement. As the Israeli Cabinet meet, I urge them to back this deal. Now is not the time for any backtracking. Both sides must implement each phase of the deal in full and on time. The history of this conflict is littered with missed opportunities. It would be a tragedy to let slip the chance before us—we must grab it with both hands. It is the chance not just for a ceasefire but for a lasting peace, and to break the cycle of violence that has inflicted so much suffering on innocent people on both sides.
The Government are committed to sustaining momentum, however fragile the process at first may be. Every hostage must be released, as set out in the agreement. Every ounce of aid promised to Gaza must reach those in need. I am sending my representative for humanitarian affairs to the region, to work closely with aid agencies, the Israeli Government and our partners to deliver on these promises.
Palestinians must also be free to return to their homes and, crucially, they will need to rebuild: rebuild their homes, rebuild their lives and rebuild their communities. They cannot possibly do that on their own. They need to feel safe and they need the international community to deliver the funds they will require. The UK had already begun to convene partners on the financing and co-ordination of recovery and reconstruction. It is essential that the coming surge of assistance is properly co-ordinated, with the access and security to get to people all that they need.
The Palestinian Authority has a crucial role to play. We want donors to support its plans for recovery, and I discussed that with President Abbas on Monday. We are providing technical and financial assistance to the PA, including to support the urgent recovery of basic services. Working with the Palestinian Authority and civil society will help lay the groundwork for an inclusive Palestinian governance in Gaza. That is the best way to re-establish local order and security. It is therefore a crucial first step in achieving not only better lives for Palestinians but a future for Gaza no longer under the control of Hamas.
Ultimately, it will take time to rebuild Gaza and rebuild trust between the two sides. I must warn the House that there are risks at every turn. But we must try to use the agreement to establish a credible pathway to a two-state solution, with equal measures of security, dignity and justice for Israelis and Palestinians alike. The decades-long conflict between Israelis and Palestinians cannot be managed; it must now be resolved.
We are not yet there and there is much negotiating still to do. As we debate in this House, fighting continues. The agreement awaits full political approval. The hostage families wait for the hostages to come home. Gazans wait for the horrors to be lifted. However, we must still recognise the significance of this moment. It has been long awaited—frankly, it has taken far too long—and I sincerely hope it is now the basis for progress: progress on bringing the hostages home, progress on bringing relief, reconstruction and hope to long-suffering civilians, and progress towards a two-state solution with Palestinians and Israelis living in peace and security; a better future for all. I commend this Statement to the House”.
16:04
Earl of Courtown Portrait The Earl of Courtown (Con)
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My Lords, I welcome the announcement of the ceasefire, as I am sure noble Lords do. This is an extremely important moment for the Middle East. However, we must not overlook—I paraphrase the Minister from the earlier Question—the fragility of the current situation or the long and challenging road ahead. Can the Minister tell the House what actions His Majesty’s Government are taking to encourage the ceasefire to hold?

This pivotal juncture was tragically precipitated by the horrific Hamas terror attack of 7 October: the worst terror attack in Israel’s history and the most murderous pogrom against the Jewish people since the Holocaust. The atrocities committed on that day stand as a chilling reminder of the dangers of allowing such groups to operate unchecked. We are heartened to witness the return of the first hostages under this agreement, including British national Emily Damari. These brave individuals, who have endured unimaginable trauma, will now face the long journey of rebuilding their lives. I hope all noble Lords will join me in praying for their continued health and well-being.

As we reflect, we must also remember the victims of those appalling attacks: those who lost their lives, those murdered in captivity and those whose lives have been irrevocably altered. The cruelty of Hamas over the past 15 months underscores the necessity of holding such groups accountable. Every single hostage must be safely returned to their loved ones and the international community must continue pressing for their unconditional release. Can the Minister tell me what actions His Majesty’s Government are taking to support the safe return of all hostages?

I echo the Foreign Secretary’s acknowledgement of the essential roles played by Qatar, Egypt and the United States in facilitating this agreement. These efforts underscore the importance of diplomatic engagement, and the UK must continue to be an active partner in supporting the next steps to ensure that the ceasefire holds.

In other debates in your Lordships’ House, we have looked at humanitarian assistance. Could the Minister say what additional humanitarian assistance the Government are planning to provide to alleviate the suffering of civilians affected by the ongoing conflict, particular in Gaza? How will the logistics work? From what I have heard in this House before, part of the problem is the logistics of getting the aid to those who need it. I look forward to the Government’s response and their continued commitment to playing a constructive role in this critical moment for the Middle East.

Lord Purvis of Tweed Portrait Lord Purvis of Tweed (LD)
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My Lords, I agree with the noble Earl that this is an incredibly fragile situation, and I acknowledge the caution in the Foreign Secretary’s remarks and tone in the House of Commons last week. It is fundamentally a cessation of hostilities rather than a peace agreement, and there is still a very high level of uncertainty in many areas for the days and weeks ahead.

I also wish to put on record the work of the intelligence services of Qatar, the USA, Egypt and Israel. It was noted that, until fairly recently, Prime Minister Netanyahu refused diplomatic negotiations; it was all led by the intelligence services. However the agreement was made, we all hope that it will be sustainable.

I also share the noble Earl’s welcome for the fact that many families are now being reunited with the hostages. It is a tragedy that many families are waiting for the bodies of hostages, rather than live hostages. Hamas should never be forgiven for their actions.

There will be many in Israeli society who were shocked at the armed al-Qassam Brigades being very visible on the streets. Many had assumed that, as a result of the IDF’s actions, Hamas was removed, but it still looks as though it is very present. Does the Minister agree with the previous US Secretary of State, Antony Blinken, in his assessment, which he made public, that Hamas has recruited the same number of fighters today as it has lost? What is the Government’s assessment of the current standing of Hamas, and how will that have an impact on any relationship with Fatah and the PLO in the Palestinian Authority?

On reconstruction, the needs are enormous. I will not repeat the question I asked the Minister in Oral Questions some minutes ago; I will just put on record that I agree with everything he said in response. I hope that the Government will find a way of ensuring that education for children in the region is at the top of our priorities. One of the consequences of conflict is that it is often the next generation that is more radicalised than the previous one. Given the scale of the conflict in Gaza, we all fully understand that, without interventions now in relation to child trauma, psychosocial support and education support, there will be potential threats and danger in the future.

On the situation in the West Bank, what is the Government’s assessment of the report of concessions that the Israeli Prime Minister gave to the remainder of the extreme right wing in his Cabinet? According to those reports, while there could be support for the agreement on Gaza, there are now to be far more IDF and Israeli actions in the West Bank—leading to full annexation, as one continuing Minister in the Israeli Government said. Will the Minister state that that is unacceptable to the UK Government? Will he put on record that we will not follow the new Trump Administration in removing the sanctions that were put in place on the settlers for the violence that they had carried out against innocent communities in their own home areas? Will the Government also take the opportunity to reject the fact that the United States has reinstated supply of the Israeli Government with 2,000-pound bombs, which can bring about only mass destruction of community areas?

On the longer term, does the Minister recognise that my noble friend Lady Northover’s Private Member’s Bill, which we will now debate on 14 March, is an opportunity for us to consider the validity of a two-state solution and the need for the recognition of a state of Palestine? If there is to be diplomatic work on both reconstruction and some form of political way forward, the viability of a Palestinian state needs to be in place.

Finally, I acknowledge that the Government have increased support for the Palestinian Authority, as the Foreign Secretary has indicated. However, our support is still way below the level before the 2018 aid cuts. What is the Government’s intent in respect of replenishing the humanitarian reserve so that we can provide extra support and restore fully the level of governance support to the Palestinian Authority that we provided before the previous Government cut ODA from 0.7%?

Lord Collins of Highbury Portrait The Parliamentary Under-Secretary of State, Foreign, Commonwealth and Development Office (Lord Collins of Highbury) (Lab)
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I thank both noble Lords for their questions and contributions. As the noble Earl, Lord Courtown, repeated, this is a fragile situation. The deal is incredibly fragile, so we have to do everything possible to ensure that we can build confidence on all sides to help sustain the ceasefire and move it from phase 1 to phase 3 and into a lasting peace. It is important to turn this deal into a political process that leads us to the two-state solution. That is the only way to ensure, in the longer term, peace and security for both Palestinians and Israelis.

I join the noble Earl in welcoming the release of the three hostages in Gaza, including, of course, British national Emily Damari. I too place on record our thanks to Qatar, Egypt and the US for their support in bringing these individuals’ and their families’ horrific ordeal to an end. Our thoughts are also with those still waiting to be reunited with their loved ones, including the families of United Kingdom-linked hostages Eli Sharabi, Oded Lifshitz and Avinatan Or—three people who should be reunited with their families.

I shall focus on how we build the future and stability. For the deal to work, parties need to co-operate to make sure that the ceasefire lasts and moves towards a lasting peace. Planning for governance, security and reconstruction must be predicated on progress towards a Palestinian state, with Gaza and the West Bank united under one Government, and the Palestinian Authority must play a key role. The security arrangements must protect both Israelis and Palestinians and, as we heard in the previous Question, allow the safe distribution of aid. We will continue to work with Israel, the Palestinian Authority, the US and regional partners, including Arab and Gulf states, to build consensus for a post-conflict Gaza governance and security framework that supports the conditions for a more lasting and secure peace. Stability in the West Bank is crucial to ensure that the fragile ceasefire in Gaza can last. All sides should work to ensure a lowering of tension in the West Bank at this time.

On Palestinian statehood and support for Palestinian reform, as the noble Lord said, the Foreign Secretary has spoken with President Abbas and the Prime Minister of the Palestinian Authority, Mohammad Mustafa, and offered the United Kingdom’s support as his Government implement much-needed reforms. An effective PA is vital for lasting peace and progress towards a two-state solution. Our long-standing position has been that we will recognise the Palestinian state at a time that is most conducive to that process—not the end but as part of that process. We remain absolutely committed to that.

As I say, this ceasefire provides an opportunity to get aid in—and we have heard that just under 1,000 trucks got in in one day last week. We need to ensure that that continues. I shall not repeat what I said in response to the Oral Question. We have given the funding and, as the noble Lord said, we need to focus on medical and educational support. Obviously, the longer-term rebuilding of Gaza needs a much bigger investment. In addition to the £112 million, we have matched up to £10 million of public donations—we should not forget that. The United Kingdom public have been absolutely concerned, and they have matched their concern with money through the Disasters Emergency Committee Middle East humanitarian appeal, which has provided life-saving aid, including medical supplies, shelter and clean water, to people in the West Bank.

We have to ensure that the process delivers that longer-term building of confidence and dialogue. I was concerned when I read in the Guardian this morning about increased levels of violence in the West Bank. As the noble Lord pointed out, we have moved to sanction those responsible for violence in the West Bank and announced designations against eight extremist Israeli settlers and nine entities known to have supported, incited and promoted violence against Palestinian communities. We will not hesitate to take further action if it is needed. The UK is deeply concerned by IDF military operations in the occupied West Bank.

16:19
Lord Austin of Dudley Portrait Lord Austin of Dudley (Non-Afl)
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My Lords, one of the tragedies of Gaza has been that aid has been looted by the corrupt, murderous gangsters of Hamas, and that money and materials that should have been used to build hospitals, schools and housing have been used instead to pay for weapons and to build tunnels from which to attack Israel. What are the Government going to do to prevent aid that they give in future being stolen and abused like this?

Lord Collins of Highbury Portrait Lord Collins of Highbury (Lab)
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I tried to answer that in the Oral Question. This is an obligation on the Palestinian Authority. We have been supporting the Palestinian Authority security services through training. We have also urged the Israeli Government and the IDF to protect the distribution of humanitarian aid to ensure that it reaches those people who need it. We are absolutely determined to work with all parties to ensure the effective distribution of humanitarian aid—it is vital that it gets to the people who need it most.

Lord Harries of Pentregarth Portrait Lord Harries of Pentregarth (CB)
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Following the noble Lord, Lord Purvis of Tweed, I shall focus briefly on what is happening in the West Bank, which is a potential conflagration. We know that Hamas is represented there, and it can become only more embittered if settler attacks on Palestinian villages continue. It was good to hear the Minister say that the British Government are going to maintain sanctions against settlers who attack those villages. As we know, President Trump has said that he is no longer going to keep up those sanctions. Will the Minister encourage the Government to make it perfectly clear, publicly, that we are going to continue to maintain those sanctions?

Lord Collins of Highbury Portrait Lord Collins of Highbury (Lab)
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I must admit I thought I had made it clear that we will maintain those sanctions. We are extremely concerned at the increased level of violence, and we have conveyed this to the Israeli Government. The ceasefire is fragile, and we need to build confidence. The noble and right reverend Lord is absolutely right that such confidence relates not only to Gaza but to all the Occupied Palestinian Territories. We are committed to ensuring that this fragile ceasefire and peace process moves towards a more sustainable, long-lasting peace, which requires a two-state solution. That is what we are committed to, and so are the United States Government. We need to focus on that; where we have common support, we need to ensure that we work together. President Trump has been working with the Saudis to ensure that they can come into the process of the Abraham accords. The Saudis want to see a two-state solution, and that is what we are all working towards.

Viscount Hailsham Portrait Viscount Hailsham (Con)
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Does the Minister agree that if, at the end of the initial period, Israel renews the war in Gaza, as is called for by some right-wing Members of the Government, such action, without clear, obvious and compelling justification, will do immense damage to the international standing of Israel and to its moral reputation?

Lord Collins of Highbury Portrait Lord Collins of Highbury (Lab)
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I am not going to speculate on what might happen. The point I would make is one that was made by the noble Earl, Lord Courtown. We are in a fragile situation. We have a ceasefire, which we have been demanding for many months, and now that we have it we need to ensure that, during this fragile process, we build confidence for the future. That means taking a step-by-step approach, with all parties, and not looking backwards at the horrors of the past but to the future, with hope for prosperity.

Lord Bishop of Manchester Portrait The Lord Bishop of Manchester
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My Lords, I declare my interest as chair of the United Society Partners in the Gospel, one of the oldest Anglican global mission agencies. One of our key partners is the al-Ahli hospital in northern Gaza, a hospital that the people of that area rely on pretty well entirely now for any healthcare they can get. Most of the hospital has been destroyed—both the library and the historic church are now in use as wards. What assurances can the Minister give us about how we can get aid into the hospital, so that the people of northern Gaza, no matter how long the ceasefire lasts —I hope it will become permanent, but for the time being—will be able to get the medical help they need? Over 1,000 emergency patients are being admitted every day.

Lord Collins of Highbury Portrait Lord Collins of Highbury (Lab)
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I agree with the right reverend Prelate. As I said in response to the Oral Question, we are very much focused on getting medical aid and support in, particularly to northern Gaza. I mentioned the £5.5 million in funding for UK-Med to run field hospitals in Gaza. We focus on all the areas where there is most need, but I agree with the right reverend Prelate that we need to do more to ensure that those who need medical treatment get it speedily.

Baroness Foster of Aghadrumsee Portrait Baroness Foster of Aghadrumsee (Non-Afl)
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My Lords, we all hope for a permanent ceasefire; that is the wish of everybody in this House. At the end of the Statement, thoughts turn to reconstruction and the need for the international community to deliver the funds for that reconstruction. Given that it has been recently reported by Forbes that Hamas is the second-richest terrorist organisation in the world, can this Government not find a way to capture some of that money, so that we can put it towards reconstruction in Gaza?

Lord Collins of Highbury Portrait Lord Collins of Highbury (Lab)
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One thing is clear: there is no role for Hamas in the future. That means that we have to work with all parties, particularly those in the region. I mentioned before that we continue to work with Israel, the Palestinian Authority, the United States and regional partners, including Arab and Gulf states, to build a consensus for a post-conflict Gaza governance and security framework that supports the conditions for a permanent and sustainable peace. We are prepared to convene partners and to help lead efforts to ensure that there is international and regional support for security, governance, recovery and reconstruction. It is vital that the whole of the region pulls together, and I am pretty confident that we will be able to do that. I hear what the noble Baroness says about Hamas; there can be no role for an organisation that has committed such horrific crimes.

Lord Stevens of Birmingham Portrait Lord Stevens of Birmingham (CB)
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Given that the Minister has rightly said that there can be no role for Hamas, has he seen the well-sourced reports from independent news agencies—such as the one from Reuters today—showing that, as we speak, it is Hamas thugs who are controlling the distribution of international humanitarian aid in north Gaza, as well as controlling the movement of the long-suffering Gazans themselves? How can Gaza be reconstructed and peace be secured while, in practice, Hamas appears to still be in control?

Lord Collins of Highbury Portrait Lord Collins of Highbury (Lab)
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The important thing is that we are working with the Israeli Government and the Palestinian Authority to focus on the security issues the noble Lord points to. That is why we are supporting the Palestinian Authority in its security mechanisms. The Israeli Government also have a duty to ensure that there is proper distribution of that aid, to northern Gaza in particular. It is pretty obvious that the situation is quite fragile, as was seen by the evidence of the release of hostages, but we are absolutely committed. The solution lies in ensuring that the Palestinian Authority has the ability to conduct its security operations.

Lord Ahmad of Wimbledon Portrait Lord Ahmad of Wimbledon (Con)
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My Lords, I welcome the tone and substance from the Minister and both Front Benches, which reflects the unity of purpose in your Lordships’ House. While I agree with much of what has been said, we must engage directly on the importance of the “day after”, because it is here and now. That means grasping the plans which already exist and building on the framework of the Abraham accords and the three Arab states, including Egypt and Jordan, which are at peace with Israel. We have initiatives, such as the Arab peace initiative and more recently the plan put forward by former Prime Minister Olmert and former Foreign Minister of the PA, Nasser al-Kidwa. These plans exist; they are incremental and structured. Surely we can ensure that the UK Government play their part in the process which is needed now and which runs in parallel with the long-term objective of ensuring that a two-state solution is delivered.

Lord Collins of Highbury Portrait Lord Collins of Highbury (Lab)
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The noble Lord is absolutely right; there are these plans and discussions, which we need, and the United Kingdom is happy to convene whatever meetings we possibly can. Working with the United States, the Israeli Government, the Palestinian Authority and in particular the Gulf and Arab states together is the way forward to ensuring that there is sustainable peace that delivers security for the people of Israel and Palestine. That is what we are all seeking and the noble Lord is right that we need to bring together all these initiatives that show real commitment to peace.

Baroness Goudie Portrait Baroness Goudie (Lab)
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My Lords, we are pleased to be at the stage of peacebuilding. Does the Minister agree that it is important that local women are involved at every level and at every peace table? It is local women who know what is required. They know how the buildings need to be rebuilt, they know about schools and they know that they do not want children to be taught in tents. They want to have proper, safe schools built and the opportunities, if possible, for further education, not necessarily in Gaza but close by when it comes to universities and other forms of education.

There is also the question of health. If we do not have proper hospitals brought into areas, there is no hope for maternal health and for cancer patients and other patients. So, we ought to agree now with everybody that women have to be at every peace table, because without that we are not going to get real peace. We have seen what happened in Northern Ireland. It is still the women of Northern Ireland who are keeping the peace going. So, I would like the Minister to give an undertaking on this and to come back on where those of us who are involved in this House can be of assistance.

Lord Collins of Highbury Portrait Lord Collins of Highbury (Lab)
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The noble Baroness is absolutely right. We have both been engaged in focusing on the women, peace, and security agenda, which the noble Baroness, Lady Hodgson, has been so committed to, and I am glad to see her in her place. What I tried to convey in my response to the Oral Question was the role in terms of reconstruction of civil society and, as my noble friend points out, women can be an absolutely critical part of that reconstruction and peacebuilding. The noble Lord, Lord Purvis, raised the question of focusing on children and education in particular, but women also have a critical role in delivering that peace process. That is why we are working with the PA as well to ensure that women are involved and engaged, as she says.

Lord McDonald of Salford Portrait Lord McDonald of Salford (CB)
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My Lords, the country in the Middle East that had the worst 2024 was Iran. At the beginning of 2025 there are indications that Tehran wants to return to the negotiating table. When Mr Trump was the 45th President of the United States, he took the US out of the JCPOA. Now that he is the 47th President, will His Majesty’s Government urge Washington to re-engage with the JCPOA from a position of greater strength?

Lord Collins of Highbury Portrait Lord Collins of Highbury (Lab)
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I hear what the noble Lord says, but we have to recognise that we condemned Iranian attacks on Israel. We have seen what Iran is capable of doing and how responsible it is for malign activity, most recently on 14 October. We have been focusing on calling on Iran and its allies to refrain from further attacks to de-escalate the situation and to support the opportunity for an agreed ceasefire.

Now that we have that ceasefire, we can work with our regional allies to ensure that there is a process that can deliver a more sustainable peace for the whole region. The mechanism for doing that has to be open to further dialogue. We cannot be prescriptive in the way that the noble Lord hopes to be. We know that mechanism delivered a much safer world in terms of nuclear proliferation, so we need to engage and focus with our allies in looking at the possible mechanisms to achieve that.

Baroness Blower Portrait Baroness Blower (Lab)
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My Lords, I wonder whether my noble friend knows that, over quite a lot of years—probably coming up to two decades—the international teacher trade union movement has worked extensively with teachers in Palestine, offering training and curriculum development. I include the Nordic countries, France and certainly Britain. I have been into Palestinian schools and looked extensively at the curriculum and I can assure my noble friend—and hope that he will agree—that UNRWA does not engage in indoctrination.

Lord Collins of Highbury Portrait Lord Collins of Highbury (Lab)
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Like my noble friend, I had the opportunity to visit the Occupied Territories and I certainly visited schools. I looked at many of the facilities that UNRWA provided, and they are an essential mechanism for delivering that humanitarian aid. My noble friend makes a very important point, which again raises the issue of the role of civil society. Like the initiatives she mentioned in terms of teachers, there is a role for all kinds of civil society. We have heard about faith groups—I would mention trade unions. I had a long association with the Palestinian trade union federation. I think we can do more to encourage civil society from all quarters to support that reconstruction. So, I agree with my noble friend: there are great opportunities for the future here.

Lord Walney Portrait Lord Walney (CB)
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I know the Minister is not going to dismiss the substantial evidence that has built up over the years of extremist poison being injected into the minds of young Palestinians through the school system. But, whatever the past, does he agree that it is very hard to see a more tolerant future if this were still to occur? Will he commit the UK to make clear to the Palestinian Authority that any further support for it will be contingent on there being no extremism within the education system?

Lord Collins of Highbury Portrait Lord Collins of Highbury (Lab)
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Building confidence and trust is not an easy thing to do over the long period of conflict that we have seen, and that is true of every area of conflict. We need to ensure that we define what peace means and what are the benefits and dividends of it, because there are great opportunities in Palestine and in Israel to develop economic progress in a way we have not seen before, and that peace can deliver. That is what we need to focus on. Looking back to old definitions, particularly the terms of terrorism, can hold back the building confidence process. I have spoken to many Israeli organisations working for peace in Israel and they are focused on ensuring that they look to the future, that we do not look at the past, and that we certainly build trust among young people.

Lord Bellingham Portrait Lord Bellingham (Con)
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My Lords, can the Minister clarify whether the Foreign Secretary has met US special envoy Steve Witkoff yet? Can he also clarify what he said about the two-state solution, because surely this is the only way forward in the future to find a realistic peace? Would he also agree that this will work only if the State of Israel does actually now desist from the settlement programme on the West Bank?

Lord Collins of Highbury Portrait Lord Collins of Highbury (Lab)
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We have made our position clear, as has the noble Lord, Lord Ahmad. We have been consistent about settlements in the Occupied Territories, we have been consistent in terms of the duties on Israel and we have condemned any extension of settlements. We have made absolutely clear, as the noble Lord, Lord Ahmad, said, that the previous Government and this Government are committed to that process, and we have made clear to the Israelis the consequence of undermining the possibility of a secure Palestinian state.

The Foreign Secretary has visited Israel and the region on three occasions since taking office. Every time he has visited, he has visited the Occupied Territories. I am pretty certain he has met the envoy, but I cannot give the noble Lord that assurance—I am not absolutely certain—but he has been heavily engaged in this process. As I said at the beginning, we have been making very serious calls about the ceasefire, we now have it, it is fragile and we need to be committed to ensure it is sustainable.

Mental Health Bill [HL]

Wednesday 22nd January 2025

(1 day, 2 hours ago)

Lords Chamber
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Committee (3rd Day)
Relevant document: 10th Report from the Delegated Powers Committee. Welsh Legislative Consent sought.
16:40
Clause 8: Appropriate medical treatment: therapeutic benefit
Amendment 46
Moved by
46: Clause 8, page 14, line 17, at end insert—
“(iii) seeks to minimise the patient’s distress and promote psychological wellbeing and recovery from any childhood trauma;”
Earl Howe Portrait Earl Howe (Con)
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My Lords, as well as moving Amendment 46, I will speak also to Amendments 47, 53, 54 and 95 in this group. These amendments have one central aim in common, which is that of maximising the therapeutic benefit of being cared for in a secure mental health unit. That aim should be common to all mental health patients, young or not so young, but it is largely the concerns of younger mental health patients which have prompted these amendments.

Blooming Change is a small independent charity whose membership is comprised of children and young people who have experienced detention in mental health in-patient units in England as children. It is at their urging that I have tabled Amendments 46 and 47. I have done so after hearing some first-hand accounts of incidents in which children in mental health settings have been treated in a fashion that is the very opposite of therapeutic, by which I mean treated with a lack of understanding, with an obvious vindictiveness, sometimes, and sometimes even with outright cruelty.

It is perhaps hard to imagine this happening when we know how professional and caring most staff in mental health units are, but I am absolutely persuaded that it does happen, and not just rarely. Medical interventions such as nasogastric feeding or sedation are threatened and used as punishments. Patients who have raised concerns with their parents have been silenced by their parents being told by staff that they should take no notice of the concerns, because the child was either unwell or lying.

One young person reported as follows: “Young people on section were essentially incarcerated, yet still not able to voice views or share how they felt or generally engage with their treatment. This would lead to overuse of medical interventions or the threat of this, leading to young people living in fear and not having a way to raise concerns. Many of these things had a long-lasting impact on me. Had this coercion not occurred and medicalisation not been used as punishment, I would have been able to access treatment and recover, instead of the treatment compounding my illness and in many ways contributing to me being stuck in the cycle”.

Blooming Change has pointed out the significance of childhood trauma as a factor underlying a large number of mental health admissions involving young people and the challenging behaviour that they then exhibit. The problem is that, all too often, the link between childhood trauma and the way that a patient behaves is not recognised or understood. As a result, someone with autism or a severely troubled and traumatised young people person going into meltdown —as was well described, incidentally, by my noble friend Lady Browning during our first day in Committee —is simply viewed as wilfully disruptive or downright disobedient, with punishments doled out in response.

16:45
What can be done about this? The Minister will not thank me if all I do is come up with problems without suggesting answers. The best answers must surely lie in promoting greater transparency and greater patient empowerment. Alongside that, we must find ways of fostering that vital degree of understanding on the part of mental health staff as to the root causes of certain challenging behaviours, to enable them to respond in the right way.
As far as greater transparency goes, part of the remedy may lie in the lap of the CQC. In part to assist the CQC, I suggest in Amendment 95 that, after discharge from hospital, there is a place for a debriefing process, whereby children in particular are given an opportunity to feed back their experiences during their time as in-patients—first, as a way of holding institutions accountable and, secondly, to enable those individuals to heal from those experiences by being listened to and taken seriously.
This debriefing process need not be resource intensive. There is a clear case for using technology as much as possible to facilitate the feedback. However, the hospital management then needs to assimilate the feedback in whatever way it sees as appropriate, and on the back of that to instigate necessary change. What often gets lost in hospitals is institutional memory. This would be one way of building an institutional memory and protecting it.
There is a need for such a process. Again, Blooming Change quotes one of its members as saying:
“I’ve never felt more unsafe than when I’ve been on wards. I think they’re the most scary place that a child or young person could ever be. It’s a catchphrase, ‘hospital makes you worse’ … Everyone makes jokes about going into hospital with one problem and then leaving with trauma, new behaviours, new diagnoses, assaults, PTSD – it’s awful”.
It is depressing to put this on the record, but there is research that shows that the experiences of in-patient care from children and young people are consistently poor. A survey conducted by Mind in 2023 found that 69% of young people surveyed said that their experiences in hospital had not been positive. The Children’s Commissioner has uncovered similar stories.
One part of the story, as I have indicated, is children receiving poor therapy; the other part is children receiving no therapy—or no therapy that is appropriate. Blooming Change has told me that it has members who have been child patients in mental health in-patient units who had no access to therapy of any kind. One said: “In the wards I’ve been on, they just drugged us and restrained us … we left with even more trauma and no help in place, so then we would end up back in hospital and the cycle would repeat. So much pain could have been prevented had the wards had better things in place”. Another put it even more succinctly: “Without therapy, mental health unit become prisons”.
Hence my Amendment 53, which proposes that, where suitable therapy is available to a particular patient, there should be a duty on the part of the hospital to offer the treatment to that patient, without any compulsion for the patient to accept and receive it. Therapy should not be used coercively. The best safeguard against this happening is the presence of psychologists in the in-patient unit as the professionals best placed to ensure that the environment of the unit is genuinely therapeutic.
In that same spirit, I am proposing in my Amendment 54 that, for a patient with autism or a learning disorder, there should be a higher hurdle than usual to allow any departure from the patient’s wishes as to a preferred treatment, as expressed either in an advance choice document or by the patient’s nominated person. The hurdle should be a requirement that two appropriately qualified clinicians would need to agree that such a departure was right for the patient.
There could, of course, be circumstances in which two clinicians might conclude in good faith that a patient’s express wishes should be overwritten—for example, where there was a doubt over the bona fides of the patient’s nominated person. But the point of the amendment is to add an extra layer to patient autonomy when the morale and mental equilibrium of the patient is so very shaky. I hope the Minister can provide some words of reassurance on these very troubling and sensitive matters. I beg to move.
Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD)
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My Lords, my Amendments 50 and 51 are both about the importance of non-drug-based interventions. As the noble Earl, Lord Howe, said, this group is all about maximising therapeutic benefit. I am very supportive of all the amendments in this group and my amendments are complementary to those just introduced very powerfully by the noble Earl.

I am the first to admit that I am not a clinician, and it is, of course, vital that individual decisions about treatment are made by qualified clinicians. But I am firmly of the view that, in the right circumstances and where clinically appropriate, non-drug-based interventions can be highly beneficial.

New Section 56A establishes a clinical checklist. An approved clinician will be required to go through this checklist when making treatment decisions to ensure that any given treatment is appropriate. Amendment 50 would make it clear that non-drug-based interventions are included in the alternative forms of medical treatment available, which must be identified and evaluated as part of the checklist. In short, it will establish beyond doubt that clinicians must consider and evaluate the use of non-drug-based interventions when they make decisions about treatment.

Non-drug-based interventions can cover many things, such as psychological and talking therapies, counselling, occupational therapies, art and creative therapies, physical exercise, physical activities—the list goes on. It is vital that evidence-based non-drug-based interventions are thought about, identified and considered equally when treatment decisions are made.

As I said in our discussions on Monday—this point was also just made in the introduction to this group—autistic people and people with a learning disability are too often overmedicated in hospital settings. Again, although medication may be appropriate in many places, people cannot and should not be left on their wards with little to no other meaningful therapeutic input other than that medication.

People must be seen as human beings in the round when these treatment decisions are made. That should be reflected in the type of treatment offered, including non-drug-based interventions, such as talking therapies, which are adapted to the individual and have a real prospect of offering therapeutic benefit, either in place of or in addition to medication. I readily acknowledge that treatment can involve either. That judgment is for a clinician to make.

I was very encouraged that the Joint Committee on the Bill recognised in its report the importance of non-drug-based treatment and recommended that the code of practice makes clear that appropriate treatment includes non-drug-based treatment. However, to ensure the Bill aligns with the principle of therapeutic benefit, it is important that this emphasis on non-drug-based interventions is reflected in the Bill.

It is well known that the transition from children’s services to adult services can be particularly difficult when it comes to overmedication and failing to adequately deliver non-drug-based interventions. This has included cases where young autistic people on children’s wards have been provided with some level of speech and language therapy, arts and crafts, and general help with establishing a routine. However, when the transition is made to post-18 adult services, the quality of care can drop off markedly, with no non-drug-based therapeutic treatment delivered, leading to a decline in well-being. In many ways, as has already been said, this is little different from being held in a cell.

Having a wide range of these interventions means that in-patients can have greater choice and control over their care—another key principle of the Bill. The use of non-drug-based therapies in hospital is important, not only to provide a therapeutically beneficial environment during detention but to ensure some essential continuity of support after discharge.

My Amendment 51 differs from Amendment 50 in that it would apply only to autistic people and those with a learning disability detained under Part III. It would ensure that the clinical checklist is followed when treatment decisions are made when making those decisions includes specific consideration of whether non-drug-based interventions are more appropriate in place of, or in addition to, medication.

As we have already discussed, one of the most significant changes in this Bill is the change to the detention criteria in Part II, Section 3. This means that autistic people or people with a learning disability cannot be detained under Section 3 unless they had a co-existing psychiatric disorder. However, this is not being applied to Part III patients—that is, those detained through the criminal justice system. This means that autistic people and people with a learning disability can continue to be detained for “treatment” in mental health hospitals under Part III, even if they do not have co-existing psychiatric disorders. One of the concerns about the Bill, as we have heard, is that a consequence of poor implementation could mean that more autistic people and people with a learning disability are diverted into the criminal justice pathway to get round, frankly, the new detention criteria for Section 3.

It could well be the case that Part II patients who are autistic or have a learning disability will exhibit behaviours that challenge, for which certain psychotropic medications can be prescribed. These medications can include anti-depressants, anti-seizure or anti-psychotic medications, sedatives or stimulants. NHS England’s website states:

“People with a learning disability are thought to be 16 times more likely and autistic people 7 times more likely to be prescribed an antipsychotic than the general population”,


despite existing guidance that people should be given psychotropic medication for only the right reasons, in the lowest dose and for the shortest time.

I simply conclude by saying that the focus on non-drug-based interventions in these amendments is not about saying that medication should not be used. Indeed, it can be highly beneficial in many cases. It is about ensuring that other factors that contribute to therapeutic benefit are always considered and put on an equal footing.

Lord Crisp Portrait Lord Crisp (CB)
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My Lords, I will speak to Amendment 148, which is in my name and that of my noble friend Lady Hollins. I also support all the amendments in this group. Indeed, on the ones introduced by the noble Earl, Lord Howe, I very much support the stories that we have heard and which he spoke about at Second Reading. I also note the points made by the noble Baroness, Lady Tyler, about non-drug therapies, which relate very much to what I will talk about.

I will make one general point: a generational change in the whole field of mental health is happening globally, with a shift towards more social interventions and preventions. This wider context needs to be recognised a bit more in the Bill. Amendment 148, which is about withdrawal from dependency-building drugs, is part of that context. I also agree very much with the point that the noble Baroness, Lady Tyler, just made that drugs are needed, and with the powerful points raised by the noble Baroness, Lady Fox, in the last day in Committee on the real pressures and problems that people within the NHS and beyond face in working with some of the people they end up having to work with, and on the conditions that they are working in. This emphasis on social interventions, therefore, is not at the expense of other aspects of mental health.

Some of these interventions do harm. I will come on to the point about withdrawing from drugs. On reducing prescribing and supporting withdrawal, I do not understand why this Government, through the Bill or otherwise, are not making changes that could help to reduce costs and improve services, which would take pressure off all services and, indeed, improve people’s economic position by enabling them to be fit to work.

17:00
The highest-profile issue here is antidepressants because, very sadly, of recent tragedies that have been very much in the news. I shall talk about antidepressants, where it seems the best evidence is available. Over the past 12 years, antidepressant prescriptions alone have almost doubled in England, from 47 million to 89 million last year. Nearly one in five people over 18—adults—in England is now prescribed them annually and, sadly, nearly 450,000 children and young people, almost 4,000 of them under 10, were prescribed antidepressants in 2022-23.
I am going to talk not about unnecessary prescribing and the tragic deaths associated with some of these prescriptions but withdrawal. The figures that we have managed to obtain show that up to one-quarter of adults on these drugs report their withdrawal, their coming off the drug, as being severe, and a significant proportion—while there are no particularly accurate figures here, the best estimates are about 10% of them—will experience withdrawal that is both severe and protracted. If one takes that as a minimum, we are talking about something like half a million people. What we mean by protracted withdrawal is withdrawal that lasts many weeks or months or longer as they try to come off these drugs. They are often in mental and physical pain and unable to work. Of course, this is a largely hidden crisis affecting patients one by one in the privacy of the home and often known only to relatives, close friends and service providers.
Focusing not just on antidepressants, reviews by the previous Chief Pharmaceutical Officer and others show that possible reductions in the use of dependency-forming drugs, not just antidepressants, could save £500 million in drugs alone, without taking any account of other savings to the NHS and the contribution that people could make to the economy.
This is a very practical amendment. Its purpose is what I have described so far. There is evidence now of what works in helping people to withdraw from these services. The amendment calls for four things. First, integrated care boards should provide local withdrawal services based on this evidence. Secondly, they should ensure that relevant professionals know about and are trained in these services. A number of GPs have talked to me about how individuals have had to try to manage without support, and the GPs feel without support as well. Thirdly, there needs to be reporting to Parliament on progress with this. Fourthly, at the national level, there needs to be a 24-hour helpline to provide support to patients.
I suspect that the Minister and the Government understand and support the intention behind this amendment but, in the language of your Lordships’ House, will be minded to resist it. I do not think this issue is going to go away. The prescription of antidepressants, as I have already said, has become far more high-profile in recent weeks, and the Government may yet find themselves forced to act. This amendment provides the opportunity to do precisely that. This is a story of both human tragedy and an unnecessary financial drain on the country.
A final point I shall make is that it is strange that there is no requirement on the NHS to deal with problems that have been caused by drugs that have been, with the best intentions and often successfully, administered to patients, but have led to harm thereafter. With cytotoxic drugs in cancers, I believe the NHS does a lot to support people with their impact. Why is it that in this particular case, in mental health, when we know that these drugs cause a significant problem for a significant number of people, we do not recognise that there is a responsibility for the NHS to help people to come off them in the appropriate way?
If the Minister is minded to resist the amendment, can she tell the House how the Government propose to deal with these massive problems of withdrawal? I am very happy to receive a letter or to have a meeting to discuss this. I commend the amendment to the House.
Lord Mawson Portrait Lord Mawson (CB)
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I support Amendment 148 from the noble Lord, Lord Crisp. I have just arrived back from a three-day event with Professor Brian Cox in Northern Ireland, where we had been bringing together the NHS, schools, the business community and the public sector around a whole programme on innovation and how we think about the future with regard to these matters, taking the principles that we originally developed at the Bromley by Bow Centre in the East End of London, now nationally across the country.

If I look like I am in recovery, it is because I am—I have literally just landed trying to get back here. I apologise that I could not take part in the Second Reading, because being a working Peer, sometimes it is not very easy to fit all this into the diary. One does one’s best.

I am very aware of the questions that the noble Lord, Lord Crisp, is raising. Indeed, I tabled a number of Written Questions this week about this very matter. I support the amendments because we have a very serious problem out there. My GP colleagues are telling me, as the noble Lord, Lord Crisp, has said, that one in five adults in England is on antidepressants; it is one in four in Scotland. This is a really serious problem.

As a country, we need to return to a discussion and a conversation, as the Health Secretary—I hope, in the spring—prepares to help us rethink the future of the NHS. We need to return to the question that we asked 40 years ago in the East End of London, the fundamental question: “What is health?” What we see happening here is serious for hundreds of thousands of people and is driving a culture. We also need to start to worry about what is happening within the machinery of the NHS and the state, as it drives these sorts of cultures.

Finally, as I put down in one of my Written Questions, we need to be asking, practically, “How much is it costing the taxpayer to drive these kinds of cultures?” It is serious, but the problem is also an opportunity, if interest is raised in the work of those of us who have been doing stuff on the front line for many years with our GP colleagues. I see the noble Lord, Lord Clement-Jones, there: we have rebuilt a street together, with a £40 million school, a £60 million health centre, 600 homes and now a primary school, exploring this, in what when we began was a dysfunctional housing estate.

There is a real opportunity out there, but we now need to get real about antidepressants.

Baroness Fox of Buckley Portrait Baroness Fox of Buckley (Non-Afl)
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My Lords, I have some points I would like to probe in this group.

I especially welcome Amendment 95 and the proposed new clause:

“Ascertaining and learning from patients’ experiences of hospital treatment”.


The noble Earl, Lord Howe, made very powerful and moving points; we could really take those on board. I have some reservations, however: we live in a complaints culture. I am concerned that this important notion of learning from patients’ experiences does not become a way of stigmatising hospital staff and psychiatrists, with people queueing up to point the finger. There are many people I know who have experiences of hospital who will, at a particular time, tell you it was a terrible experience, and then, at another time, acknowledge that it saved their life. It depends on what phase they are in, in relation to their illness, in some ways—it is about their perspective. So I both welcome it and challenge it.

I am very keen, as we all are, that treatments are taken seriously, whether administered in hospital or in the community. As the noble Lord, Lord Crisp, and the noble Baroness, Lady Hollins, note in Amendment 148—for me, the most important amendment in this group—we need to be alert to when, for example, the use of psychiatric medication as a treatment creates a problem of dependency. We all know that this is a growing problem. We must consider that.

On the tenor of Amendments 50 and 51 from the noble Baronesses, Lady Tyler and Lady Bennett, on non-drug-based forms of medical treatment, I am less convinced by the emphasis here. I am worried about simply giving a wholly positive view of psychological and therapeutic treatments, because it perhaps misses some of the changes in today’s culture that lead to the overprescription of, for example, antidepressants.

When I was working in community mental health many moons ago, the fashion among progressives in the therapeutic community was often anti-psychiatry, anti-hospital and most definitely anti-pharmacological interventions, with a huge hostility to the pharmaceutical industry. I did not always go along with it, but that was the kind of mood. Peculiarly, I would argue that, today, it is therapeutic experts, counsellors and psychological practitioners who, by becoming diagnostically trigger-happy in labelling people as ill, are creating a huge demand both for third-party interventions, as I have discussed in previous speeches, and for treatment. That often leads to a clamouring, especially among younger people, for pills to help them to cope with the travails of life, and it has been egged on in some ways by therapeutic practitioners.

I had my attention drawn to this when, at the Academy of Ideas, I organised a debate on young people, mental health and those kinds of issues. The audience was largely young people, who said that the problem was that psychiatrists, GPs and doctors would not listen to them and would not believe that they were mentally ill. They demanded treatment and were quite aggressive. It was young people saying, “Where are my tablets?”, and I thought, “Oh, life’s changed slightly”. The psychiatrists in the room were trying to hold the line and gently suggest that maybe they were not ill, but that led to an even more hysterical reaction: “How dare you say I’m not ill?” They went on to explain how they had had a chat with their school counsellor, and they were sure they were ill, and they wanted the tablets.

If we can take a popular example that I appreciate might get me into the heart of an argument that I do not want to be in regarding the slippage between autism and mental illness, I am going to talk about ADHD. ADHD is the fashionable disorder of the day. Huge numbers of students and school pupils are demanding that their neurodevelopmental disorder is recognised and catered for. In my view, it is often diagnosed promiscuously and that is leading to huge demands that are detrimental to education and likely to make councils go bankrupt and schools collapse—but that is for a different debate and a different Bill. ADHD is also leading to a demand for tablets.

I go along with those who were warning about overdiagnosis. The Times reports that 278,000 people in England are on central nervous system stimulus to treat ADHD, and there was an 18% hike in prescriptions for ADHD drugs between April 2023 and March 2024. In the US, the figures are startling, and we should be wary of them, with 7 million American children who are said to have ADHD. As the New York Times has said, there is a danger that we are using stimulants to suppress

“all spontaneous behaviour in normal children”

by pumping them with Ritalin and other calming drugs and sedating normal children. In a broad sense, that is a worry.

Talking of treatments, I think the noble Lord, Lord Crisp, made the point that a social problem is being created of people feeling that if they are ill, they cannot go to work and of over-giving them drugs. All sorts of problems go along with that. Is it not tragic that so many people want to have these drugs, either for themselves or for their children, in order to feel that they can cope, when they are really not that ill or not ill at all, but they have the label? I am wary of inappropriate treatments, but perhaps the problem needs to be looked at differently, as stemming from inflated and expansive diagnostic criteria often deployed from within the therapeutic community rather than psychiatry.

We should not be naive in thinking that non-drug-based therapeutic interventions are virtuous per se. Counselling, for example, has extended its reach into British society so much that it is now a rare family that has no experience of the phenomenon. I am sure that we all know that going to a therapist or counsellor is, to say the least, a mixed bag when, ironically, they end up saying that you need to have third-party intervention or medical intervention. It is bad for the nation’s health.

17:15
Baroness Bennett of Manor Castle Portrait Baroness Bennett of Manor Castle (GP)
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My Lords, I will be brief, but in following the noble Baroness, Lady Fox of Buckley, I have to note that I do not believe that a complaints culture is a problem in the contexts covered by this Bill. There is, perhaps, a lack of listening to patients and those affected, and a lack of action rather than a problem with listening to complaints. In that context, I commend the noble Earl, Lord Howe, who cited extensive testimony from Blooming Change. One thing that struck me when looking back over the previous days of Committee was that it would have been good to hear, perhaps even more than we did, direct testimony and the voices of those who are experts by experience. The phrase “nothing about us without us” really stuck in my mind and it is important that we keep that in mind throughout Committee. Again in response to the noble Baroness, Lady Fox, I think it is important not to seek to downplay the mental health crisis that we are seeing across our society. There is a huge shortage of services meeting people’s very clear and acute needs, and acute needs are what we are largely covering in this Bill.

I attached my name to Amendments 50 and 51 tabled by the noble Baroness, Lady Tyler of Enfield, which address non-drug-based interventions. In essence, I agree with everything the noble Baroness said; I just want to stress her points. When we talk about non-drug-based therapies, we are tempted to think we mean talking therapies and psychological therapies. Those are tremendously important, but this is where we also need to take the broader public health context. I mentioned on an earlier group digital treatments such as Avatar for those who hear voices. They are the kind of new, different ways of looking at things that people may not have been trained in, and it is important that they are considered. I also talked a fair bit about the gut-brain axis and dietary interventions such as green prescribing, in which we have seen great advances across the medical fields in recent years—exposure to green spaces and the chance to get exercise in green spaces. That makes me think that we need to think about facilities and how we make sure there is provision within them, which, in some ways, this amendment would help to cover.

As a noble Lord said earlier, we are talking about making sure we are treating the whole person and not a condition with a drug. I thought the contribution from the noble Lord, Lord Crisp, was very important, as is his amendment. I am not sure whether it needs to be in the Bill, but it would be interesting to have the Minister’s comments on making sure that consideration of withdrawal symptoms is part of prescribing practice. That is absolutely key and central. I note a report from the universities of Berlin and Cologne out last year which showed that the second-most prescribed antidepressant in the UK, venlafaxine, also has the second-highest rate of problem withdrawal symptoms. We need to make sure that is carefully considered pre-stage—before we get to the withdrawal stage, are we going to create that problem? I do not know whether it could be incorporated in the amendment, but it is something to think about anyway.

The other amendment—slightly oddly—in this group in my name is Amendment 154, which again, as on a previous group, I put down at the request of the Law Society. It is about mental health tribunal pilots for challenges against treatment decisions. To some degree, we have already discussed this in the earlier group, but I would be interested in whether the Minister has any comment on the amendment. I think that it is fairly self-explanatory, so I will not go through it further.

Lord Scriven Portrait Lord Scriven (LD)
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My Lords, I shall speak to Amendments 54A and 54B in my name, which are on a very narrow part of the treatment plan for individuals. Before I do that, let me say that I support the amendments in this group, particularly the general thrust of what been said; that is, that the automatic medical model must no longer be the default position and a much more social model must be added on to the medical model so that they complement each other.

Having said that, I listened very carefully to the noble Baroness, Lady Fox, but found it very difficult to understand what was required. She argued against the use of medication but then argued against quite a lot of the non-medicated issues. Her intervention was a bit confusing in terms of understanding what the importance was.

My amendments are predominantly about Clause 18, which is about the use of ECT. The clause allows for the emergency use of ECT based on a second medical opinion. The element I wish to speak to is the very wide Henry VIII power that the Government wish to give themselves in regulations to do away with the second medical opinion in an emergency. The Bill says:

“The appropriate national authority may by regulations amend this Act to provide for circumstances in which functions of a second opinion appointed doctor in relation to treatment falling within section 62ZA(1) may or must be carried out instead by the approved clinician in charge of the treatment in question”.


New Section 62ZB(3) then says:

“Regulations under this section may make … (a) provision subject to specified exceptions; (b) different provision for different cases; (c) transitional, consequential, incidental or supplemental provision”.


That is quite a wide Henry VIII power.

To prove that I really am Billy No-Mates and do not get out often on a cold night, I read the wonderful 10th report of this Session from the Delegated Powers and Regulatory Reform Committee, which makes exactly the same points but in more eloquent language. This is a very wide Henry VIII power, and the committee does not really understand why the Government are seeking—even though it is through the affirmative procedure—such wide powers in such broad language.

The committee said that it would expect the power to be drafted with significant limitations and a framework for when it could be used. My amendment seeks to do exactly that. It would not prevent the clinician in change from using ECT in an emergency case without referring to a second practitioner in certain circumstances, but the regulations would be within a framework laid out in Amendment 54B, that

“the treatment is immediately necessary to save the patient’s life … obtaining a second opinion would cause a delay that places the patient at a significant and imminent risk of death or serious physical harm, and … the treatment is reversible”.

The regulations would have to be written so that

“Any amendment made under subsection (1) must specify the exceptional nature of the circumstances in which the second opinion may be dispensed with”.


A report to Parliament on subsection (1) dispensations would also have to be made.

I believe, from reading the wise words of the Delegated Powers and Regulatory Reform Committee in its report, that it is important that the regulations have a framework, so that the Minister still has flexibility but is constrained by what is in the Bill. That is why I have spoken to this amendment.

Baroness Murphy Portrait Baroness Murphy (CB)
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My Lords, I feel I must poke my nose in on these of amendments, even though I do not have an amendment. I support the noble Earl, Lord Howe, and his various amendments. I particularly like the amendment that would require children and their families to be asked the month after how it all went.

We are hearing described the appalling nature of many mental health services. It is not just children’s services. Although they may be a very good example, as many of them are not fit for purpose, we would get the same complaints and the same appalling state of affairs if we went around other mental health services across the country. It is heartbreaking. I truly believe that services have deteriorated since I practised in hospitals. People, including my former colleagues who are still practising, say that services are completely disorganised and not fit for purpose. We have known for 50 years that the social model of care was an appropriate model, and that you need psychological and social psychotherapeutic interventions, as well as any drugs that might be helpful. They are not going on because there is no availability anywhere.

We have known since at least the 1960s that patients with schizophrenia, for example, can benefit by being taught, one-to-one, about how to interact with people when they are recovering from an episode. That never happens, because we do not employ teachers in the NHS—we just do not do it. We do not employ the right sort of people and we do not have the right sort of facilities. When people are employed, there are so few of them that it is simply impossible to do what is necessary. I am not defending this, because there are some very good units—I am sure that there are some very good children’s and young people’s units—but they are not the norm anymore, and that is a very sad state of affairs.

Sadly, legislation through mental health Bills will not, unfortunately, solve the problem. What we are talking about is not only a fundamental change of culture and getting on with all the things that we know should be done; there needs to be investment and a totally different approach to mental health. All the things that we know should be done cannot be delivered by mental health legislation alone. I say that because we are trying to shove too much into the Bill and hoping for the best, but I do not think that it will work.

Later in the debate on these amendments, noble Lords moved away from talking about people who were very unwell and who need in-patient care to talking about this vast mass of people who are diagnosed with conditions where they cannot work. That is a whole new ball game. I agree with almost every word that the noble Baroness, Lady Fox, said, because there is no doubt that there is a massive overdiagnosis of things that are called “mental disorder”, when they are in fact distress and need a different sort of approach.

A young friend of mine—a gentleman who is now in his final years training as a maxillofacial surgeon—had a period of great distress because of family circumstances. He sat down on his own one evening and went to a website, “Diagnose yourself”. He rang me and said, “I’ve been diagnosed as having ADHD”. I cannot imagine anybody who is less likely to have ADHD than this young man, who is the most socially competent young man I know. This morning, my husband and I had a go on the website together—he did one test and I did another—and we both came up with the same result: “You probably have ADHD”. Well, maybe I am, folks, but I am not going to go on the Ritalin yet. There are a lot of websites that are utter rubbish and encourage people to pay money to see psychotherapists and other counsellors to see what the matter is with them, so that other people can put money in their pockets for doing not much.

That is the different end of the spectrum. When we are thinking about these things, we have to think about what the patient has. Is it something that can be diagnosed—heaven knows that colleagues here were very keen that we should have a diagnosis—or something at the other end of the spectrum? With the Mental Health Bill, we are talking about when you can detain people, take away their rights and say, “We are detaining you”, to treat them, and protect them from wrong treatment, bad doctoring and bad staff. That is what the Mental Health Act is for.

But I am afraid that it is not to do with any of this other stuff. We have to think through what really has to be in the Bill to protect the patients and the staff and what cannot go in there because it is not relevant to these issues.

17:30
Baroness Fox of Buckley Portrait Baroness Fox of Buckley (Non-Afl)
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I want to ask the noble Baroness a question. I agree that this Mental Health Bill should be confined to and is about the people who are very poorly and could be in danger of being detained—I understand that. However, all the time when we have these discussions, we are talking about a problem with a lack of resources. In the noble Baroness’s experience, is the broader mental health crisis taking away resources and focus, not in this Bill but in society, from giving that acute mental health care the resources that it needs—because it is being spread far too thinly across ever greater numbers?

Baroness Murphy Portrait Baroness Murphy (CB)
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Yes, I would say that indeed it was. That year when they gave an extra £400,000 to spreading psychotherapy around was the same time when we were having incredible crises in acute hospital services, and I thought that it was not justified. But the mental health crisis that we have in this country is the same one that they were complaining about in 1860, 1870 and 1880; every generation believes that it is worse off than the generation before, but there is not much evidence that it is.

Baroness Butler-Sloss Portrait Baroness Butler-Sloss (CB)
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My Lords, having just heard the noble Baroness, Lady Murphy, I shall be extremely cautious about what I look at on the internet. I want to say just two or three words. I have experience from my own family and from my friends of two sets of drugs—anti-depressants and Ritalin—and they really should be used a great deal more cautiously.

Baroness Barker Portrait Baroness Barker (LD)
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My Lords, now is not the time to have the extensive debate that the noble Baroness, Lady Murphy, has opened up. I said right at the outset that we are talking about legislation that comes into play when a person is going to be detained because they are very ill and at risk of harming themselves or somebody else. But I would say to the noble Baroness that the Wessely review looked at this issue at considerable length, and I was among the Peers who listened to Sir Simon Wessely when he came to present his findings. One thing that has stuck with me is the person who gave evidence to his review who said: “I was very ill. I had to have treatment. Why did it have to feel so awful?”—I am using parliamentary language there. Does the noble Baroness accept that mental health legislation debates such as this might be limited, but they do an important thing in sometimes challenging the prevailing orthodoxy among the professions, and they are an occasion where the experience of patients, which have built up over many years, gets a chance to change practice? That is why we should look at all the amendments in this group, and in particular those of the noble Earl, Lord Howe.

Baroness Murphy Portrait Baroness Murphy (CB)
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I agree with everything that the noble Baroness, Lady Barker, has said. She is absolutely right that professions should be challenged, and that is partly what legislation can do, particularly in debates such as this. But we are losing the very important amendments from the noble Earl, Lord Howe, about young people and what we can do to improve circumstances through the Bill, and I want not to lose them, because they are very important.

Lord Stevens of Birmingham Portrait Lord Stevens of Birmingham (CB)
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Very briefly on the question that the noble Baroness, Lady Fox, raised, the notion of supply-induced demand is a well-known phenomenon across health services. However, I have to say to her that I think that we are a long way off that being the problem that is principally confronting children and young people’s mental health services. We have a massive gap between the need for effective therapies for children and young people and their availability.

When the process of trying to expand children and young people’s mental health services kicked off several years ago, the goal was that we would get to a situation where one in three children and young people with a diagnosable mental health condition would get some form of specialist mental health support. That number has now been exceeded. I was just looking at the stats published last week and, although I do not see the most up-to-date number for it, I would be surprised if more than one in two are currently getting specialist mental health support for a diagnosable mental health disorder, not just distress. So, we are a long way off confronting this problem of supply-induced demand, whatever broader cultural or therapeutic labelling questions that she rightly points to may be in the ether. Fundamentally, we are going to need more services to benefit the children and young people who need them, not pretend that this is somehow all vapourware, imaginary or a cultural deformity, unlike our predecessors in the Victorian era.

Baroness Merron Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
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I thank noble Lords for their contributions on this important set of amendments. I say at the outset that I note the various observations that are outside the Bill, as the noble Baroness, Lady Barker, pointed out, but I have noted them and I am sure we will discuss them on a number of occasions.

First, I turn to Amendments 46 and 47, tabled by the noble Lord, Lord Kamall, and the noble Earl, Lord Howe. I have heard how many noble Lords are in support not just of those two amendments but all the amendments in the group. I am sure noble Lords will not be surprised to know that I understand where people are coming from and I will be pleased to go through the response to them.

The noble Earl, Lord Howe, spoke about “troubling and sensitive matters” and about being inspired by testimonies that came through the charity Blooming Change—I express my thanks to that organisation for the work it does. Officials in the department have met the group and it made a very helpful contribution. Hearing from those with lived experience is crucial to making sure that this is the best Bill, and I know that many noble Lords have done that, so I thank the noble Earl for bringing that into these amendments.

Amendments 46 and 47 would change the definition of appropriate medical treatment to include treatment which

“seeks to minimise the patient’s distress and promote psychological wellbeing and recovery from any childhood trauma”.

Childhood trauma can of course have a devastating impact on psychological well-being. Effective and compassionate in-patient care must be informed, as I have said, in co-production with people with lived experience and be trauma informed. NHS England’s Culture of Care Standards for Mental Health Inpatient Services certainly underlines this.

The noble Earl, Lord Howe, and other noble Lords raised concerns around in-patient settings and how appropriate they are, which I understand. I hope it will be helpful to say in answer that the new definition of “appropriate medical treatment” introduces the requirement that treatment has to have a reasonable prospect of benefiting the patient. We would expect the setting in which someone is going to be detained to be considered as part of this. Of course, I am more than aware—without wanting to go into the generics in this group or any other group—that the place in which we start, in terms of the suitability and availability of the right settings, is not where I am sure any of us would want to be.

We also know that the sensory environments in settings can cause difficulties for people with sensory sensitivities. To support NHS services to address sensory aspects of the environment, which the noble Baroness, Lady Bennett, referred to, NHS England has published a sensory-friendly resource pack, which outlines 10 principles to improve the sensory environment and signposts other resources.

The clause in the Bill that defines “appropriate medical treatment” already requires decision-makers to take into account the nature and degree of the disorder and all other circumstances, which could include childhood trauma, when considering whether medical treatment has a reasonable prospect of therapeutic benefit. The definition of medical treatment is unchanged and is indeed broad, including nursing care, psychological therapy and medication. All these interventions could include an overall aim to minimise distress and promote psychological well-being.

Amendments 50 and 51, tabled by the noble Baronesses, Lady Tyler and Lady Bennett, aim to ensure that the clinician considers non-drug-based interventions as part of the new “clinical checklist”. The checklist requires clinicians to identify and evaluate alternative forms of medical treatment when deciding whether to give a particular medical treatment to a patient. As I have already mentioned, the definition of medical treatment under the Act is broad. As well as non-drug-based interventions, it includes specialist mental health rehabilitation and care. On the point raised by the noble Baroness, Lady Bennett, which is an important one, it does include the therapeutic environment or setting. This requirement, as outlined, would apply to all patients falling under Part IV of the Act. It includes patients with a learning disability and autistic patients who are detained for assessment under Section 2 and patients detained for treatment under Part III.

With specific regard to those with a learning disability and autistic people, I recognise the concern that they are more likely to be prescribed an antipsychotic than the general population. I emphasise that psychotropic medication should only be given for the right reasons, in the lowest dose, for the shortest time. NHS England has a national programme of work to stop overmedication and the inappropriate prescribing of these medications, which is aimed in particular at people with a learning disability and autistic people. Noble Lords will be aware of the STOMP programme. Alongside it is a national supporting treatment and appropriate medication in paediatrics programme called STAMP—the two are not to be confused. These programmes work particularly closely with those with lived experience, families and carers organisations, and a wide range of health and social care professional bodies.

Amendment 53, in the names of the noble Earl, Lord Howe, and the noble Lord, Lord Kamall, would require the approved clinician to offer a patient any treatment that is appropriate, having applied the new clinical checklist. The reference to medical treatment in that checklist should already be read in accordance with Clause 8, which inserts a new definition of appropriate medical treatment to enact the principle of therapeutic benefit.

The clinician must also support the patient to participate in decision-making to make sure that they do not simply offer their preferred treatment to the patient, with no discussion or consideration of alternatives. The Bill also requires clinicians and, where relevant, the second opinion appointed doctor to provide a written record that the treatment being administered meets the definition of appropriate medical treatment. Therefore, it is felt that the Bill already meets the intention of this amendment. Furthermore, if the intention is to ensure that a range of treatments is being considered by the responsible clinician, I can reassure noble Lords that this is already the case, because, as I have said, the definition of medical treatment is broad.

17:45
Amendment 54, tabled by the noble Lord, Lord Kamall, and the noble Earl, Lord Howe, seeks to ensure that, where a patient has autism or a learning disability, the approved clinician, having applied the clinical checklist, must secure the agreement of two professional clinicians before any treatment could be given which departs from the patient’s preference, as expressed by either the patient’s nominated person or the patient’s advance choice document. While we recognise that this amendment may help ensure that preferences are more central to clinical decision-making, we do not feel that this additional safeguard is necessary on top of the protections already introduced by the Bill. For example, the clinical checklist and the new rules that limit the use of compulsory treatment and require the earlier involvement of a second opinion appointed doctor achieve a similar objective. Furthermore, sometimes a patient’s preferences, or those of their nominated person, may not be clinically appropriate or practically achievable. In that situation, the amendment would create a new burden on staff, with little benefit in return. Therefore, we feel it would be better to rely on the discretion of the treating clinician in this circumstance.
The noble Earl, Lord Howe, made an important point about the need for transparency and empowerment. We certainly agree with that aim and there are a number of measures in the Bill to make improvements: for example, the clinical checklist, the compelling reason criteria and the increased oversight by the second opinion appointed doctor. I hope that this will deal with the point about transparency and empowerment.
Amendments 54A and 54B, tabled by the noble Lord, Lord Scriven, relate to the Secretary of State’s power under Clause 18 to set out in regulations the circumstances under which the requirement for a second opinion appointed doctor’s certification of urgent and compulsory electroconvulsive therapy may be dispensed with and seek to limit those circumstances. We have received a recommendation from the Delegated Powers and Regulatory Reform Committee to limit the extent of the delegated power. I can assure the noble Lord that we are considering this recommendation carefully and will reflect closely on the views that he has brought before the Committee today. I aim to clarify the Government’s position on Report.
Amendment 95, in the name of the noble Earl, Lord Howe, and supported by the noble Lord, Lord Kamall, would require an independent mental health advocate to consult with people on their experience of in-patient hospital treatment after discharge and report this to the hospital managers, who must then publish a report each year on lessons learned and actions taken.
We feel that there are already mechanisms in legislation that serve a similar purpose, which I well understand. For example, under the CQC’s statutory duty to monitor the Mental Health Act, the CQC visits and interviews detained patients. Insights from these interviews inform the findings of the CQC’s annual monitoring of the Mental Health Act. The findings from this monitoring may also result in the CQC requiring action statements from providers on what they will do to improve services. Where providers do not take the necessary action, they may ultimately be subject to sanctions under the regulatory powers of the CQC.
The noble Earl, Lord Howe, raised concerns about the debriefing process after discharge from hospital. The code of practice provides guidance on the provision of information about the complaints process. The Bill will put this requirement on a statutory footing and place a duty on hospital managers to supply complaints information to detained patients, community patients and conditionally discharged patients, as well as their nominated person.
We have been clear that improvements are needed to make healthcare regulation and oversight more effective, and the CQC is already making improvements following independent reviews. Beyond legislation, it is the responsibility of trust boards to ensure that feedback is gathered to improve services. The patient and carer race equality framework, now part of the standard NHS contract, requires that visible and effective ways for patients and carers to feed back are established, as well as clear processes to act and report on that feedback.
Lastly on this amendment, while we are committed to expanding access to independent mental health advocacy, we are also mindful of not overburdening the workforce. This amendment is likely to be resource intensive, as well as resulting in a significant deviation from the IMHA’s current role: to support people to understand and access their rights when detained.
Lord Scriven Portrait Lord Scriven (LD)
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The Minister has reeled off a very good list of what is already in place. Have the Government done an assessment to see exactly how that learning is ingrained and how effective it has been in changing mental health provision and mental health services? If not, could she please go back to her department to try to find that, and write to Members of the Committee so we can see that in writing?

Baroness Merron Portrait Baroness Merron (Lab)
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I would be very pleased to look into it further, but, as I have described, this is a rolling programme. I emphasise that the CQC has that duty both to monitor but also to make the relevant bodies subject to sanctions if needed—in other words, more immediately. So I am concerned that through this amendment we could be creating a structure which is actually less flexible and responsive than the one we have now.

Amendment 148, tabled by the noble Lord, Lord Crisp, and the noble Baroness, Lady Hollins, would impose on integrated care boards—ICBs—a legally binding duty to provide local, in-person, specialist withdrawal treatments for patients on psychiatric medication prescribed during the course of their treatment by services under the Mental Health Act. In addition, there would be a duty on each ICB to send to the Secretary of State an annual report on the availability, uptake and outcomes of this support. Under this amendment, the Secretary of State would be obliged to lay these reports before Parliament. ICBs would also be subject to a requirement to provide a 24-hour helpline and online platform to support patients to receive withdrawal treatment.

Let me say at the outset that I recognise the difficulties that withdrawal can pose. I recall that the noble Lord, Lord Crisp, spoke on this very point in the Chamber last month and was also good enough to speak directly to me. It is, I agree, an issue that will not go away and, per the noble Lord’s request, I would be happy to arrange a meeting. I feel there is a whole area here to which we today, considering amendments, cannot do justice, so I would be pleased to do that. To the noble Lord, Lord Mawson, who has tabled Written Questions, I say that I look forward to answering them, and I hope that he will look forward to reading my Answers.

Where relevant, we would expect the patient’s statutory care and treatment plan to include a tapering plan and put in place whatever additional support is needed to enable a patient’s recovery and effective discharge. On the requirement to provide support in the community and report on availability, this is the responsibility of local health commissioners. In 2023, NHSE published a framework for ICBs and primary care boards on how to optimise personalised care for patients prescribed medicines associated with dependence or withdrawal symptoms. With regard to the requirement in the amendment for a 24-hour helpline, this would not seem proportionate, given the relatively low numbers of people who might need this service, who should already have a support plan in place, including access to relevant local support services.

Finally, Amendment 154, tabled by the noble Baroness, Lady Bennett, would allow the Secretary of State to make regulations giving people detained in hospital and those subject to community treatment or guardianship orders the ability to have certain care and treatment matters considered by a mental health tribunal.

This is a very complex area, as I am sure the noble Baroness is aware. The amendment seems to draw on the recommendation made by the independent review to give patients a new right of appeal to a single judge of the mental health tribunal regarding compulsory treatment. I recall that the previous Government publicly consulted on this new right, and the majority of respondents raised major concerns in this regard. The consultation was followed by further long and careful consideration with stakeholders, which led the then Government to the conclusion that this safeguard is just not viable. A solution could not be found that provided an efficient and effective route of appeal for patients while avoiding the risks of the tribunal intervening in clinical decision-making, alongside significant resource burdens. Many of these concerns were reflected in the report of the pre-legislative scrutiny committee, which also acknowledged the complexity of the issue.

We believe that the other provisions in the Bill will better achieve the same objectives of providing patient choice and autonomy, so while we do not support introducing a new role for the tribunal, I assure your Lordships that the emphasis on therapeutic benefit within the detention criteria will mean that whether care and treatment are proving effective will play a role in the tribunal’s consideration of whether or not detention should continue to be upheld. With these explanations, I hope that the noble Earl feels able to withdraw his amendment.

Earl Howe Portrait Earl Howe (Con)
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My Lords, I am very grateful to all noble Lords who have contributed to this debate in such compelling ways, and I think we can see that when it comes to the experiences of children and young people in mental health units, we are dealing with a story that is a lot more substantial than mere anecdote. From briefing I have received, I am afraid I have been left in no doubt that the therapeutic environment in a number of mental health hospitals around the country—not all, of course—is, to put it mildly, a lot less than optimal.

Clearly, it is unacceptable for any patient, of whatever age, to be detained compulsorily without being offered treatment. It is unacceptable that drugs or restraint should be used as punishments. Challenging behaviour can be difficult to deal with, but staff should be trained to deal with it in a way that demonstrates that they understand the root causes of the behaviour. Those causes can be extremely complex.

To pick up another strand of the debate, I am in no doubt that medication has a place in mental health therapy. It can often be the treatment of choice. It is one tool in the toolbox. However, I very much agree with what the noble Lord, Lord Crisp, and the noble Baroness, Lady Tyler, had to say about social prescribing. It can not only be clinically effective but save costs if it is delivered, for example, by local charities that work in the fields of music, drama or art. Incidentally, it can help budding musicians, actors and artists in their downtime to train as music, art or drama therapists, which is an added bonus.

18:00
I am very grateful to the Minister for her response, which is helpful on a number of fronts. I am glad that she and her officials have met with representatives of Blooming Change to listen to their important perspective. I hope that some good has come out of that in so far as policy-making is concerned. Between now and Report I shall reflect on whether the issues that I and other noble Lords have raised merit further debate. From the contributions around the Committee, I think that they almost certainly do, but for now I beg leave to withdraw my amendment.
Amendment 46 withdrawn.
Amendments 47 and 48 not moved.
Clause 8 agreed.
Clause 9 agreed.
Clause 10: Nomination of the responsible clinician
Amendment 49 not moved.
Clause 10 agreed.
Amendment 49A not moved.
Clause 11: Making treatment decisions
Amendments 50 to 54 not moved.
Clause 11 agreed.
Clauses 12 to 17 agreed.
Clause 18: Urgent electro-convulsive therapy etc
Amendments 54A and 54B not moved.
Clause 18 agreed.
Clause 19: Capacity to consent to treatment
Amendment 55
Moved by
55: Clause 19, page 28, line 27, at end insert—
“(7) In section 24 of the Mental Capacity Act 2005 (Advance decisions to refuse treatment: general), after subsection (5), insert—“(6) For an “Advance decision” in relation to a treatment for a mental disorder under the provisions of the Mental Health Act 1983, a person may make a decision once they have reached 16.””Member’s explanatory statement
This amendment extends advance decisions to those who are 16 and over.
Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD)
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My Lords, in moving Amendment 55 I will speak to Amendment 136; both are in my name. This is another very important group, about children and young people’s competence and decision-making. Amendment 55 is about extending advanced decisions to those who are aged 16 and over. I recognise that there is also an important amendment from the noble Earl, Lord Howe, about advanced decisions—a similar issue, but perhaps taking a different approach.

The Bill will give legal weight to advance decisions within the Mental Health Act, which I very much welcome. Adults will be able to record their advance refusal of a particular treatment if they lose capacity. An advance decision will have the same effect as a refusal of treatment made with capacity and will ensure that the individual can access enhanced safeguards before the treatment can be given. Although advance choice documents, where advance decisions will be recorded, will be available to adults of all ages, the Bill as drafted does not permit under-18s to make advance decisions. As such, someone aged under 18 could say in an advance choice document that they refuse a particular treatment if they would not want it, but that would have limited weight. Specifically, it would mean that, if the child or young person lacked capacity or competence to consent to treatment when it was offered, their advance refusal would not give them access to the enhanced treatment safeguards that are available to adults, including tribunal appeal.

This means that, rather than being on an equal footing, children and young people would be disadvantaged compared with adults. Therefore, I see this very much as part of parity of treatment between children and adults. I am strongly of the view that the safeguards that flow from advance refusals of treatment should also be made available to young people. This is what my Amendment 55 is designed to do.

I add one more general point. We still have work to do in Committee to strengthen safeguards and protections for children and young people in mental health in-patient care. There should be a general principle of parity of treatment between children and young people and adults. Of course I recognise that some distinctions have to be made due to the legal status of under-18s, but I said at Second Reading, and it remains my view, that this Bill was never really designed with children and young people in mind, yet it can affect them greatly. In responding, can the Minister set out how much input DfE Ministers and officials have had on the drafting of the Bill?

It will probably help if I explain that Amendment 136 is closely related to Amendment 147, tabled by the noble Lord, Lord Meston, whom I have had the opportunity of corresponding with. I do not want, in speaking first, to pre-empt what the noble Lord will say, but I need to reference his amendment to explain mine. I share the concern that the Bill does not include a test to determine the ability of children under the age of 16 to make decisions—in other words, whether they are competent. Without such a test, this age group will not be able to benefit fully from the rights and safeguards included in the Bill; the question is how we best get there.

Under-16s are currently at a disadvantage. Whereas all those aged 16 and over are presumed to have capacity to make decisions for themselves unless evidence shows otherwise—in which case the Mental Capacity Act kicks in—under-16s are presumed to be unable to make decisions for themselves unless they demonstrate that they are competent to do so. There is also no clear and consistent approach for determining whether a child is competent. Although the concept of competence is generally understood, how to assess a child’s competence is not.

That is why I have a lot of sympathy with the amendment tabled by the noble Lord, Lord Meston, which would insert a test for determining the ability of someone aged under 16 to make decisions under this legislation. His amendment explicitly limits this test to decisions made under the mental health legislation and is explicitly focused on the criteria with which to determine whether a child is competent. No doubt he will explain his amendment far more eloquently than I could ever do. My amendment would require the Secretary of State to review whether a statutory test for under-16s would be expedient for the purpose of this Act and for mental health legislation more generally. It is very much a stepping stone towards that position and, I hope, supports change in this area.

Such a review is important because it could address some of the concerns that have been expressed in this area. It could include whether such a test should be in the Bill or in a code, how best to make it clear that a test will be specific to the scope of legislation rather than having wider application, and how such a test would help with the successful implementation of the Bill. It could help to establish that the test is specific to whether a particular child can make a particular decision at a particular time, and set out what information is required.

I am aware that, in some of our broader discussions, concerns have been raised about the possible unintended consequences of such a test in relation both to parental responsibility and to a child being seen as Gillick competent—that is, they have the ability to understand the decision. I feel that a review would be helpful in looking at these issues and addressing those concerns head-on. In that way, we would make important steps in ensuring that the whole of the mental health reforms work properly and fairly for all children and young people. I beg to move.

Lord Meston Portrait Lord Meston (CB)
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My Lords, as the noble Baroness has just said, my Amendment 147, which deals with competence and decision-making, would provide what I suggest is a necessary statutory test to determine the decision-making competence of children under 16 years of age in all matters under this legislation for which such a determination is required. The Joint Committee on the draft Bill pointed out, echoing what was said in the independent review of the 1983 Act, that attempts both to protect and to empower children have produced a complex mixture of statute and case law with no single method of assessment and no consistent criteria to establish either capacity or competence. This is a particular disadvantage for children and young people, who do not have the benefit of any statutory presumption of competence such as that which applies to adults.

Importantly, the amendment, although offering a test, does not create any presumption of capacity in a child. Moreover, the reason for the child’s inability to decide is irrelevant. It would, however, require that those determining whether a child is competent must give reasonable grounds for reaching that conclusion. It is important to emphasise that this amendment is concerned only with how to assess whether a child is competent and not with the consequences of any determination that a child is competent.

This Bill has been produced with numerous references to capacity and/or competence in various contexts, including consent to CETR meetings, “disclosure of information”, “consent to treatment”, making advance choice decisions,

“terminating the appointment of a nominated person”

and involving “mental health advocates”. However, the Bill is currently silent on what is meant by “competence” and how it should be determined.

The existing statutory test in the Mental Capacity Act does not apply to those under 16. The separate concept of Gillick competence—it is derived from the pivotal case of that name, decided in 1986—requires inherently subjective assessments of the child’s understanding and maturity. I speak with some experience of having to decide whether or not a child is competent to participate independently in court proceedings concerning them. That exercise sometimes feels rather paternalistic and is, as has been pointed out, really subjective, with the test in Gillick offering no guidance on the extent to which adjustment should be made for factors such as peer pressure, drug and substance abuse, family stress, emotional disturbance or illness.

More recent case law shows that the Mental Capacity Act can be used to inform an assessment of child competence, but it is not mandatory to do so. The factors set out in this amendment to indicate a child’s ability to decide are the features carefully identified by Mr Justice Cobb, as he then was, in a case decided in 2017 concerning the difficult question of whether or not a girl under 16 had the capacity to consent to her child being adopted.

I therefore suggest that there is now a need for clearer and more rigorous guidelines—structured guidelines that are not just mechanistic checklists—for mental health and legal professionals to work with. The assessments that have to be made of a child’s ability to understand and weigh relevant information need to be decision-specific, child-specific and time-specific, and they have to recognise that competence can fluctuate as well as evolve. These are not straightforward assessments and are certainly not a mere formality.

A statutory test would be welcomed by practitioners and the courts. This is too important to be left to the code of practice; such codes are intended to reflect and supplement the law, not to create law. A clear test in the statute would only be of assistance to practitioners and would allow children to benefit from the safeguards within the Bill.

18:15
I respectfully suggest that Amendment 136, spoken to by the noble Baroness, Lady Tyler, is too cautious. It calls for a review to be undertaken in 12 months to consider the expedience of a statutory test. Surely the pros and cons, and scope, of a statutory test have already been well canvassed. It is not clear to me what would be gained by further delay and review. I was tempted to suggest that a review, if not kicking the topic into the long grass, would at least kick it into touch. If we have learned anything about the Bill, it is that much of it will not be implemented with anything near the speed of light. Surely this is one topic that can now be confidently grasped and not deferred.
Baroness Browning Portrait Baroness Browning (Con)
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With the wealth of his experience in dealing with children, could the noble Lord give the House a feel for whether, when assessing the competence particularly of children from a younger age group, there are cases where they understand the situation that is explained to them but, when a decision is subsequently required, there is less clarity on how to make it themselves? I ask that because I know that, often, certain adults on the autism spectrum in a similar situation can fully comprehend a situation that is explained, if necessary, and have capacity, but making the decision between one, two or more choices is much more problematic.

Lord Meston Portrait Lord Meston (CB)
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My Lords, I understand the dilemma. The point I emphasise is that, in deciding this, one has to be clear that the child has a proper explanation of the ultimate decision that has to be made. It is to that end that the competence has to be assessed.

Lord Stevens of Birmingham Portrait Lord Stevens of Birmingham (CB)
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For those of us who are not anywhere near as legally expert as the noble Lord whose wise deliberations we have just heard, could he clarify the amendment that talks specifically about ring-fencing this new test for the Mental Health Bill? To what extent would that be consistent or not with, for example, the ruling of the Court of Appeal in Bell v Tavistock—the NHS trust—in the case of puberty blockers, which concerned the interpretation that the High Court had given to the Gillick test?

Lord Meston Portrait Lord Meston (CB)
- Hansard - - - Excerpts

I am tempted to say that I really do not know. That was a faster ball than I expected to receive. I think the answer is that the case law would be consistently applied, even as it stands now, but would undoubtedly be aided by a statutory test. Whether it would apply in cases such as that which the noble Lord just mentioned, I do not know. The purpose of the amendment is to provide a test for decisions that have to be made consequential upon this legislation, not other situations.

Baroness Butler-Sloss Portrait Baroness Butler-Sloss (CB)
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My Lords, I entirely agree with what the noble Lord, Lord Meston, just said. The two interjections were very interesting but they do not really affect the guidance. That is crucial. The question asked by the noble Baroness, Lady Browning, as to whether you can understand it but cannot make a decision, may well affect how the person applying the guidance does so. That would be one of the issues for whoever has the uncomfortable task of making the decision.

I think the noble Baroness, Lady Tyler, is too cautious. If we go back to the Mental Capacity Act 2005, there is clear explanation and guidance in primary legislation as to how anyone who has to judge capacity is to do it. What we are talking about here—incompetence—is quite simply capacity. For some reason, which I find quite difficult, we seem to think that children under 16 have competence or do not, but over-16s have capacity or do not. It would have been far more sensible to use the same word for every person who will, in fact, be judged on whether they do or do not have capacity to make a decision of great importance, as it would be, in relation to mental health issues. I find it very odd.

However, and equally importantly, if it is in primary legislation for over-16s, why on earth would it be in guidance for under-16s? If it is good enough for over-16s, why is it not good enough for under-16s? The way the noble Lord, Lord Meston, has set this out seems admirable. It is very close to the Mental Capacity Act. I take and entirely agree with the point made by the noble Baroness, Lady Tyler, but the Government seem to have ignored children to a very large extent, although children are a very important part of this Bill. I do not blame the Minister, because she did not draft it, but she has to bring it to us. I tabled a lot of amendments about parents and people with parental responsibility because they are largely ignored; I will speak about that later. But where we are dealing with children aged under 16, it is essential that they are treated in the same way as everybody else and that has to be in the Bill—in primary legislation.

Young people have had to deal with these issues ever since Lord Denning was presiding in the Court of Appeal in Gillick, but he did not help us at that stage as to how actually to deal with it. Like the noble Lord, Lord Meston, I have also had to make decisions as to whether under-16s were giving me advice that I thought was really worthy of listening to. Children of five can give extraordinarily good explanations, though I do not expect them to give them on mental health issues. I urge the Minister: it is crucial that everyone whose capacity is a matter at issue has it treated in exactly the same way. Therefore, to put it into guidance really will not do.

I will also speak on Amendments 55 and 56. I am very concerned about children. Bear in mind, however much we treat children aged over 16 with respect and as having the capacity to make decisions, and however much we listen to them, as we should listen to all children, there are stroppy teenagers—we all know about them—who, for one reason or another, will not do what adults tell or advise them. I am very concerned, and I am not quite sure about this because I am no expert on mental health legislation, that if a 16 year-old has the right to make advance decisions and they just say, “I do not want any injections, I do not want any pills, I absolutely refuse to have any treatment”, then unless there is an ability to override them they will have capacity and cannot be ignored. One has to view advance decisions for 16 to 18 year-olds with some degree of care. I am not saying that they should not happen, but I am not happy about them being universal and without some ability for them to be overridden.

Baroness Berridge Portrait Baroness Berridge (Con)
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My Lords, I have put my name to Amendment 147. I find myself in agreement with much that has been said. It has been a consistent recommendation to His Majesty’s Government since the independent review that there should be a statutory test of competence or capacity for those aged under 16. Of course, that means it should be in the Bill. This has been supported by the Children’s Commissioner of late and by the Children and Young People’s Mental Health Alliance.

Therefore, I was disappointed to see the code of practice solution outlined in the Minister’s policy paper that we received yesterday. As the noble and learned Baroness, Lady Butler-Sloss, outlined, in the Mental Capacity Act, which applies to over-16s, there is a functional capacity test followed by the secondary mental impairment test. I also agree with the noble Baroness, Lady Tyler, that under-16s are presumed to lack capacity, so you start from the opposite premise of the Mental Capacity Act for over-16s, who are presumed to have capacity. That puts them at an advantage: it has to be taken from them, rather than being given to under-16s.

I agree with the comments of the noble Lord, Lord Meston. Great work is being done by clinicians up and down the country to apply Gillick competence tests, but throughout my time on the Joint Committee we did not seem to know whether there was any review or assessment as to how and when it is applied in hospitals and healthcare settings up and down the country. I fail to understand the Government’s reluctance to put this test in the Bill. How is such a reluctance compatible with one of the four guiding principles—to treat the person as an individual? Perhaps the Minister could outline the reasoning for this omission.

I also want to point to the problem of relying on the code of practice made under Section 118 of the Mental Health Act. On page 13 of the code of practice, there is a very clear description of the code and its legislative function:

“Whilst the whole of the Code should be followed, please note that where ‘must’ is used, it reflects legal obligations in legislation, (including other legislation such as the Human Rights Act 1998) or case law, and must be followed. Where the Code uses the term ‘should’ then departures should be documented and recorded”.


It then refers to explanatory paragraphs and continues:

“Where the Code gives guidance using the terms ‘may’, ‘can’ or ‘could’ then the guidance in the Code is to be followed wherever possible”.


In the Minister’s policy statements, there is often the use of “will”, which, as far as I understand, is a “must”. Bearing in mind what I just read, unless something is in the Bill then even putting this test into the Bill will mean that it is only, at the very best, a “should” and can be departed from. Obviously, that applies across all of the places in which the Minister relies on the defence of, “We’re going to put it in a code”. I note that it is a code that we have not seen and will be consulted on only after the passing of the legislation.

Dealing again with the amendment, it is important to determine capacity and, as Mind has said in its excellent briefing, the question of whether a person has capacity or competence to make the relevant decision is fundamental to the operation of key rights and safeguards. To build on the point from the noble Lord, Lord Meston, as I understand it the Bill contains 13 references to competence. It deals with such important matters as the appointment of their nominated person and, if you are under the age of 16, your freedom to choose someone other than the person with parental responsibility depends on your having competence. There is also the ability to refuse medication. To deal with the point made, I think, by the noble Lord, Lord Stevens, who was concerned about leakage across, this is a very particular piece of legislation with such coercive power, as I am sure he is aware, that the case for putting the test in the Bill to open up those safeguards for young people is very important.

The Government’s response to the consultation stated:

“We are committed to ensuring that children and young people benefit from the reforms we plan to introduce”.


Will the Minister therefore explain again how the lack of a statutory test is consistent with maximising that choice and autonomy?

Baroness Bennett of Manor Castle Portrait Baroness Bennett of Manor Castle (GP)
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My Lords, I rise briefly having attached my name to Amendment 147, to which the noble Baroness, Lady Berridge, was just speaking so powerfully. I will not repeat anything that people far more expert legally than me have already said, but will just make a couple of small points.

18:30
I start by agreeing with the noble and learned Baroness, Lady Butler-Sloss. I have met many 10 year-olds who have a very clear-eyed vision of the world and their place in it, and they should certainly be given a voice. This is something that I have spoken about in other Bills. I think particularly of the Domestic Abuse Bill, now an Act, where there was a strongly minded debate around alleged parental alienation and the way in which children’s voices have sometimes not been listened to and they have been forced to do things strongly against their will and desires.
It is important to say that it is not just morally right that children who have the ability to do so should have a say about what is happening to them and a say in all the other ways that the noble Baroness just outlined. That moral rightness is powerfully and importantly attested to in the fourth part of this amendment, which refers to the UN Convention on the Rights of the Child. It is important that we keep referring to such conventions, but it is also important for people’s health and well-being to have a sense of agency and a sense that this is their life in which they are able to live and make choices. We heard in the earlier group from the noble Earl, Lord Howe, about Blooming Change and how people experience life being done to them and treatment being done to them, rather than it being something in which they actually have a say.
Stressing that I am not a legal expert, I was really attracted by the way in which this amendment is drafted, particularly subsection (3), which rightly puts an onus on professionals to make sure that they explain this in ways that are accessible to the child. We all know that medical and legal terminology may not be accessible to adults, let alone children, but the suggestion of simple language, visual aids or other means is a real direction to professionals to say that they have to facilitate, by any practical means possible, the chance for that child to have agency. That should be at the core of the Bill, particularly for the children who were drawn to our attention on the other group, who are some of the most vulnerable people in our society and who face potentially being locked up against their will. We have to give them as much voice as possible, which is what this amendment would do.
Baroness Barker Portrait Baroness Barker (LD)
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My Lords, I make two specific points in response to what the noble and learned Baroness, Lady Butler-Sloss, said. The amendments refer to Section 24 of the Mental Capacity Act, but if one goes on to Section 25 of that Act, there are a number of conditions that have to be fulfilled in order for a record of an advanced decision to be deemed valid. I think it is worth pointing out subsection (5) to noble Lords, which states:

“An advance decision is not applicable to life-sustaining treatment unless … (a) the decision is verified by a statement by P to the effect that it is to apply to that treatment even if life is at risk, and (b) the decision and statement comply with subsection (6).


Subsection (6) states that it must be,

“in writing … it is signed by P or by another person in P's presence and by P's direction … the signature is made or acknowledged by P in the presence of a witness, and … the witness signs it, or acknowledges”

it to be true.

I am trying to convey to the noble and learned Baroness that these are very formal procedures. They are not taken lightly. That applies to somebody who is 18 and one day, and I think it should be applied to somebody who is younger than that with as much seriousness.

Noble Lords and others have referred to these decisions as advance decisions to refuse treatment. Advance decisions can also be for treatment. People can say in an advance decision, “I know that when I am in an episode of illness, I may be saying that I do not want medication. At this moment in time, when I have capacity, I wish it to be put down in writing that if I do that, you are to ignore it”.

I would like us to have a fuller appreciation of what it is we are talking about, although I do not detract from any of the considerations that people want to bring in about young people.

Earl Howe Portrait Earl Howe (Con)
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My Lords, I venture to say that all the amendments in this group approach similar issues in not dissimilar ways. The most compelling point that perhaps should be underlined in relation to them all is that implied by the amendments in the name of the noble Baroness, Lady Tyler, and the noble Lord, Lord Meston: that there is no earthly reason why the law should prohibit a young person with sufficient decision-making competence recording a valid expression of their wishes and preferences around their own mental health care, and the logical consequence of that is the need for a competence test, or a capacity test for child patients.

My Amendment 56 seeks to address an issue allied to those addressed by the noble Baroness, Lady Tyler, and the noble Lord, Lord Meston. As it stands, the Bill does not permit a 16 or 17 year-old to make a valid advance decision about their mental health care. An advance decision has the same effect in practice as a capacity decision to refuse a particular treatment. It is important to understand that under the Mental Health Act, making an advance decision does not give someone an unfettered right to refuse that treatment. Treatment can still be administered notwithstanding the advance decision, albeit only if certain strict conditions are met. Nevertheless, an advance decision made by an adult patient carries a huge amount of weight, and placed within or alongside an advance choice document, which enables a patient to outline their treatment preferences, it does a great deal to ensure that the patient is placed genuinely in the driving seat when it comes to their mental health care and treatment.

Under the terms of the Bill, young persons aged 16 and 17 will be able to execute an advance choice document, but what they cannot do is to make an advance decision to sit alongside it. That means that an advance choice document that purports to include an advance decision made by an under 18 year-old is likely to carry a good deal less weight than such a document executed by an adult. My amendment invites the Government to put this right.

An associated but distinct issue arises in relation to children under the age of 16. I will not repeat the excellent arguments for a competency test put forward by the noble Lord, Lord Meston, and the noble Baroness, Lady Tyler, but I agree entirely with what they have said. The point that resonates most with me in the context of a Bill that places great emphasis on patient empowerment is that in the absence of a statutory competence test to determine a child’s decision-making ability, it will, in practice, be impossible for someone under 16 to execute an advance choice document and then expect professionals to take due notice of it.

Amendment 147, tabled by the noble Lord, Lord Meston, seems to me to be as good as it gets in articulating the key requirements necessary to establish decision-making competence in a child. My only hesitation about his amendment is that it invites us to place the terms of a competency test in the Bill without further ado. For a measure of this significance, I tend to feel that any final formula for a competence test merits a prior consultation exercise, and then encapsulation in regulations approved by Parliament. I fully agree with my noble friend Lady Berridge that relying on a code of practice in this context would be wholly unsatisfactory. For what it is worth, I suspect that a consultation would be likely to throw up some further considerations that would need to be factored in to the formula. That aside, I very much hope that the Minister will be receptive to the arguments she has heard. If we can deliver this added empowerment to children and, as regards advance decisions, to 16 and 17 year-olds, the prize will be very great, and I hope she agrees that the challenge is one we must address.

Baroness Butler-Sloss Portrait Baroness Butler-Sloss (CB)
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My Lords, if the noble Earl is suggesting that the provisions in the amendment of the noble Lord, Lord Meston, should go either to consultation or to further consideration, will we not end up in a situation where this Bill becomes law and nothing is done to advise anyone, on the face of the legislation, how to deal with those under 16, although it is there for those over 16? Why should, in this particular instance, those under 16 basically be discriminated against? Whether or not they have capacity is the point of the amendment.

Earl Howe Portrait Earl Howe (Con)
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I am grateful to the noble and learned Baroness. I hope it was implicit in what I said that I would look to this Bill to include an order-making power that would enable regulations to be laid in due course that would cover not only 16 or 17 year-olds but also those under 16, and Parliament would then approve them. No doubt this is a matter that we can discuss further after this, but I hope that the point of principle is clear, which I fully support, that this issue needs to be sorted through this Bill.

Lord Scriven Portrait Lord Scriven (LD)
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I have listened to the noble Earl’s argument carefully, and in principle I support what he is trying to do. The only problem with leaving the matter to a statutory instrument, rather than putting it on the face of the Bill, is that it is far easier for the Secretary of State to change that, even despite the will of Parliament, based on the way that Parliament works. Why could it not be on the face of the Bill, to give absolute certainty, rather than in a statutory instrument, which normally gives flexibility and powers to a Minister?

Earl Howe Portrait Earl Howe (Con)
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There are two answers to that. First, it is generally unthinkable for a Government to lay regulations without first having consulted the relevant parties. Secondly, if we are honest, putting something on the face of a Bill is not the whole story; there would need to be proper clinical guidance published alongside that for practical purposes for hospitals and elsewhere.

Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, I thank all noble Lords for examining the important issues that have been raised in this group of amendments.

Amendment 55, in the name of the noble Baroness, Lady Tyler, supported by the noble Lord, Lord Scriven, seeks to change the Mental Capacity Act to allow young people aged 16 or 17 the ability to make a binding advance decision to refuse medical treatment for mental disorder. I shall set out some concerns about the amendment that may be helpful.

First, the amendment would mean that a young person who is not detained under the Mental Health Act could refuse a mental health treatment, even if it was life-sustaining. While the Mental Health Act and the Bill currently provide safeguards that enable a person’s advance decision to be overruled, detention under the Act may not always be appropriate. For example, if a 16 year-old is left very unwell following an attempted suicide, then currently they may be given treatment on the basis of what is in their best interests, under the Mental Capacity Act, if they lack capacity to consent at the time. However, under the amendment, if the 16 year-old had made an advance decision to refuse treatment necessary for their recovery or to sustain their life, then they might need to be detained under the Mental Health Act simply so that their advance decision could be overruled. This is important in terms of timely access to treatment and to avoid loss of life, of course.

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Secondly, to take forward this amendment would be to deviate from a long-standing legal principle established by common law in the courts. With this in mind, there is a risk that a young person’s advance decision would be challenged by the parent and overturned by the courts, making this new right potentially meaningless or at least somewhat unclear.
Thirdly, the amendment could result in an asymmetry with physical health treatment—which I know the noble Baroness would not wish to see, and I completely understand that—regarding whether treatment could be refused in advance. This is likely to create some confusion among health practitioners, especially where it is not clear whether the purpose of the treatment is to address a physical illness or a mental illness or both. An example would be the use of nasogastric tube feeding under the Mental Health Act to treat a young person’s eating disorder. This confusion could potentially result in legal challenge and a delay in treatment, which would of course potentially risk a young person’s health and safety, although I know that is not the intention.
Baroness Bennett of Manor Castle Portrait Baroness Bennett of Manor Castle (GP)
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What the Minister has just said is complex, but it strikes me, listening to that situation, that this might be a matter of hard cases making bad law. Could we be denying lots of people the chance to have a say because of the risk in a small number of cases? How would she respond to that?

Baroness Merron Portrait Baroness Merron (Lab)
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The overall concern is as I have identified. Yes, indeed, as always, it is a complex area that we need to unpick, but our main concern has to be for the welfare of the young person. The concern about the amendment is that, inadvertently, it would work in the opposite direction.

To finish on Amendment 55—this might also be helpful to the noble Baroness, Lady Bennett—we are of the view that the Bill strikes the right balance between self-determination and responding to the needs and vulnerabilities of children and young people. For example, in the clinical checklist, many of the new treatment safeguards and provisions around care and treatment planning apply equally regardless of age and aim to ensure that treatment is more patient-led.

Amendment 56, tabled by the noble Earl, Lord Howe, and supported by the noble Lord, Lord Kamall, is somewhat similar to Amendment 55 in seeking to change the Mental Capacity Act to provide a mechanism by which children and young people can make an advance decision to refuse medical treatment for mental disorder. However, under Amendment 56, the child or young person’s advance decision would have legal weight only if they were detained under the Mental Health Act. As I have already discussed, while we recognise the principled position to extend the rights of adults to children, giving under-18s the right to make an advance decision to refuse treatment would conflict with a long- standing legal principle established by common law in the courts and codified in the Mental Capacity Act and would, therefore, mean that the amendment would not achieve its desired effect. This principle recognises that, in some serious cases, the courts, parents or those with parental responsibility may overrule the refusal of a child or young person, especially in cases where the child’s life is at risk.

I reassure noble Lords that we are nevertheless committed to giving children and young people a voice as far as possible when it comes to decisions about their care and treatment. I refer again to the example of the clinical checklist, which requires consideration of a patient’s wishes and feelings, including those expressed in advance.

Lord Scriven Portrait Lord Scriven (LD)
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What legal status does the checklist that the Minister keeps referring to actually have?

Baroness Merron Portrait Baroness Merron (Lab)
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I will come back to the noble Lord on that, and I thank him for asking the question.

I was about to refer to the noble Baroness, Lady Tyler. I may not be doing so in quite the right place, so I hope she will forgive me, but I do not want to lose this point. She asked what engagement we have had with the Department for Education. Our officials have engaged with DfE officials on the development of the Bill, including on the interaction between the Bill and the Children Act, which I know is of quite a lot of interest to noble Lords. We have also discussed questions around the statutory test with both the DfE and the Ministry of Justice, given that competency tests apply in wider children’s settings than mental health. I hope that is helpful.

Amendment 136, tabled by the noble Baroness, Lady Tyler, would require the Government to hold a review of whether a statutory test of competence should be introduced into the Mental Health Act for under-16s within a year of the Bill being passed. While we recognise that there are competing views about Gillick competency, it is nevertheless the established framework for determining competency for children. To introduce a statutory test for under-16s only under the Mental Health Act is likely to risk undermining Gillick, which remains the accepted competence test for under-16s across all settings, including reproductive health and children’s social care, and the wider legislative framework on matters related to children.

Baroness Butler-Sloss Portrait Baroness Butler-Sloss (CB)
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The trouble with Gillick is that it does not provide, for those who have to make the decision, how to do it.

Baroness Merron Portrait Baroness Merron (Lab)
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I appreciate the point that the noble and learned Baroness has made. As I said, I know there are competing views about its application. I reiterate the observation that it is the current established framework, but I hear what she is saying about what she believes are the implications of that.

Baroness Berridge Portrait Baroness Berridge (Con)
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The Minister’s own policy document says that this test should be in the code of practice. How does that not also contribute to the undermining of Gillick that the Minister refers to?

Baroness Merron Portrait Baroness Merron (Lab)
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Actually, my feeling about the code of practice is something that I wanted to bring up, because it has come up quite a lot. The code of practice is statutory and aimed at practitioners, and it allows nuance and so on, but Gillick is in case law and it guides us throughout. The point I am trying to make is that if it is changed in respect of this Mental Health Bill then that has implications across the wider question of competency for younger people, and that is of great concern.

Baroness Butler-Sloss Portrait Baroness Butler-Sloss (CB)
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I apologise for interrupting the noble Baroness again, but the fact is—I speak as a former lawyer and judge who applied Gillick—it does not actually give guidance. All it says, as I understand it, is that under-16s have to be listened to. That is great, and I totally agree. What it does not do—but the amendment of the noble Lord, Lord Meston, would—is set out the guidance that those who make the decisions need to have.

Baroness Merron Portrait Baroness Merron (Lab)
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Obviously, I am listening closely to the noble and learned Baroness’s experience and feeling on the matter, and I will certainly be pleased to reflect on the points that she and the noble Baroness, Lady Berridge, have made.

If I continue, that may be of some assistance—we will see. It is of concern to me that the possible creation of two different tests will potentially cause further confusion and uncertainty on the ground. We are therefore not in a position to welcome a statutory test of competence in the Mental Health Act.

Before I continue to Amendment 147, I will come back to the good question raised by the noble Lord, Lord Scriven, about the legal status of clinical checklists. Because they are in the Bill, they are a statutory requirement for clinicians, to be followed in respect of all patients. I hope that will be useful.

Lord Scriven Portrait Lord Scriven (LD)
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It is useful, but it is therefore contradictory to what the Minister has just said. If the checklist is statutory and it is legally binding that it has to be followed, how would a young person in that checklist having a view about their care be different from an advance directive? That is the issue. The Minister said the other alternative is that a person under 18 or 16 can make a decision in relation to the medical checklist, and she has just said that the decisions are legally binding. Alternatively, is it that carrying out the process is legally statutorily binding but the views of somebody who is 16 on that list are not?

Baroness Merron Portrait Baroness Merron (Lab)
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I was referring more to situations, of which I know the noble Lord is aware, where there is a need for intervention. I think I used the word “overruling”, and I used some examples where there was a risk to life. So it is about application in that regard. I will look at that question in greater detail when I reflect on this area of debate and, if there is more that I can add to assist the noble Lord, I will be pleased to do so.

Amendment 147 is in the name of the noble Lord, Lord Meston, supported by the noble Baroness, Lady Berridge, and spoken to by the noble and learned Baroness, Lady Butler-Sloss, and the noble Baroness, Lady Bennett. It would create a statutory test of competency for children in respect of decisions under the Mental Health Act. Under that test, competence for under-16s would be defined by reference to the functional test of capacity established in the Mental Capacity Act but without the diagnostic test, and by having due regard to the UN Convention on the Rights of the Child.

The courts have already made clear that the approach of the functional test is not suitable for children. We do not think that the functional test is appropriate or compatible with the UN Convention on the Rights of the Child, which the amendment itself makes reference to. The amendment, as drafted, is therefore not considered to be in line with established case law.

The noble Baroness, Lady Berridge, asked about the justification for not including a test in the Bill. As I have mentioned, Gillick is established in case law, not statute, and the code explains how the Gillick decision is to be applied. But this does not mean that the House of Lords decision is not mandatory. There is a duty to follow case law. It is not discretionary, as I know noble Lords are aware.

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The introduction of a statutory test under the Mental Health Act would not necessarily override the application of Gillick competence in these settings. As I mentioned earlier, the possible creation of two different tests is likely to cause further confusion and uncertainty, which I know noble Lords would not want to see. Any legislative change which sought to replace Gillick in one setting could also lead to challenge of its application in other areas, including other health settings.
I can assure noble Lords that we will keep an eye on this but we do not, in all honesty, intend to open this issue in the immediate term, given the broad application in a range of settings, and the wider sensitivity around matters relating to the ability of children to make decisions in relation to healthcare, care and education. We will consult on the guidance for assessing competence in mental health settings in the revised code of practice. With this, I hope noble Lords will feel able not to press their amendments.
Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD)
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My Lords, I thank the noble Baroness for that response. One thing we can all agree on from this discussion is that these are complex issues and people sometimes have rather different understandings of what certain things might say or mean.

Having said that, I would just like to say where I think we are on the two issues. First, on advanced decisions, I have a strong view that children and young people aged 16 and 17 should have choices that are made available to adults extended to them. As I think the noble Baroness, Lady Bennett, said, it is about having a sense of agency and autonomy and feeling that their wishes and feelings are being respected. It may be that I did not draft it very well, but I was not suggesting that everyone was going to be forced to do it. It is there as an option, and that is a really important point that possibly did not come out sufficiently in the debate. The fault for that is mine. It may be that the approach that the noble Earl, Lord Howe, was suggesting is a better way forward. I do not know; I do not mind. I just feel that, because to me this is so fundamental and a question of human rights, we will need to return to this on Report.

I turn with some trepidation now to the statutory competence test for under-16s. I have been accused of being too cautious. That is fine. I understand where noble Lords were coming from. I did not say it when I introduced it, because I thought it would be a bit to odd to say it, but I was seeing my amendment as a bit of a backstop. In other words, if the Government are not minded to accept that recommendation, at least something would happen and at least there would be some sort of progress. As I said, I was very sympathetic to the test and the way that the noble Lord, Lord Meston, set it out. It had a fair amount of support, of course, across the Chamber, but the debate also showed that there are still some quite tricky issues that need to be teased out. I do not think it was quite as clear-cut as perhaps was being suggested, not least about issues around the consistency or otherwise of the application of Gillick.

It may be that, again, I did not get the wording right when I talked about a “review”. I accept that. Reviews can be kicked into the long grass and you never see anything again. But I thought the idea of a consultation was very important and, in fact, I think it would be quite difficult, having listened to this debate carefully, to move straight to having something in the Bill without having some sort of consultation first. It might be that you would want to take some sort of powers that would enable such a thing to be put in place after that consultation had happened, but to me it just felt that some issues still needed to be teased out.

Perhaps my initial amendment was not completely ludicrous, but it has been a really good and interesting debate—

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD)
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Probing, absolutely. Thank you. And again, on this issue I sense that we will be returning on Report. But, having said those things, I thank all noble Lords who participated in this debate and thank the Minister for her responses. I beg leave to withdraw the amendment.

Lord Meston Portrait Lord Meston (CB)
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My Lords, I do not want to prolong this, but I have to say that, although I am disappointed and a little surprised by the response from the Government, the intention is to align the Mental Capacity Act and Gillick. It is frankly not correct, if I understand the situation, to say that it is not based on case law. I referred to a specific case in which the judge formulated, essentially, the test that appears in my amendment. As I say, I do not want to prolong this but, if necessary, I can refer the Government to that case.

Baroness Merron Portrait Baroness Merron (Lab)
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Perhaps I can just say to the noble Lord that, when I reflect on the discussions on this group, as well as all the others, it may be helpful to discuss this further.

Amendment 55 withdrawn.
Amendment 56 not moved.
Clause 19 agreed.
Clause 20: Care and treatment plans
Amendment 57
Moved by
57: Clause 20, page 29, line 2, at end insert—
“(ba) is a patient who has been informally admitted to a mental health unit in accordance with section 131, or”Member’s explanatory statement
This amendment would ensure that patients who are admitted informally to a mental health unit will also benefit from a care and treatment plan.
Lord Kamall Portrait Lord Kamall (Con)
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My Lords, Amendment 57 stands in my name and that of my noble friend Lord Howe. The amendment is an attempt to ensure that patients who are admitted informally to hospital for a mental health disorder are also able to benefit from a care and treatment plan. As noble Lords will be aware, the Bill introduces statutory care and treatment plans but, as drafted, extends that right only to a select group of patients. As per the new Section 130ZA(2) of the Mental Health Act, patients who will be eligible for these plans are those who are formally detained under that Act, those who are subject to guardianship under the Act and those who are under a CTO.

I do not think there is any disagreement that these patients rightly deserve access to a care and treatment plan. But what about informal patients who voluntarily admit themselves for treatment? The Explanatory Notes explain that the purpose of putting these plans on a statutory footing is

“to ensure that all relevant patients have a clear and personalised strategy in place describing what is needed to progress them towards recovery”.

They also detail some of the possible inclusions in that care and treatment plan.

I note, however, that the exact inclusions in the care and treatment plan are to be made by the Secretary of State by regulations at a later date, possibly due to consultation. So, although we may have some idea of what might be included, it would be helpful if the Minister could confirm to your Lordships what the Government envisage will be included or could be included. I am not wanting to put the noble Baroness too much on the spot here.

As many noble Lords might well know, care and treatment plans have been part of the package of mental health treatment in Wales since June 2012 under Section 18 of the Mental Health (Wales) Measure 2010. Those regulations specify that the areas that must be included in the patient’s care and treatment plan include

“finance and money … accommodation … personal care and physical well-being … education and training … work and occupation … parenting or caring relationships … social, cultural or spiritual … medical and other forms of treatment including psychological interventions”.

Can the Minister confirm whether the care and treatment plans in England will follow the same format or possibly be inspired by the same format? Will there be differences? Are there England-specific issues?

I hope the Minister will understand that I have a few more questions. How will the Secretary of State decide what to prescribe in these plans? What level of consultation will there be? Indeed, what level of consultation has there been to date to inform this, particularly with the clinicians who will be responsible for drawing up the care and treatment plans?

One of the things that many noble Lords have discussed during this debate is the fact that we want to see evidence-led practices. We know that, particularly in mental health but also in physical health, these can help to inform care and treatment plans that have a positive impact on clinical outcomes and therapeutic benefit, because they are based on treatments unique to the patient’s needs.

A meta study in 2023 in the United States found that evidence-based practices

“improve patient outcomes and yield a positive return on investment for hospitals and healthcare systems”.

I note the Minister has referred a number of times to the Government making and implementing these changes when resources allow.

The Social Care Institute for Excellence has also highlighted the importance of person-centred care, writing:

“Research on mental health and wellbeing demonstrates that involvement leads to improved service outcomes and enhances mental wellbeing”.


The institute argues forcefully that care plans for mental health patients should include active involvement from the patient. It is therefore vital that care and treatment plans are not developed in a silo; they should be developed in conjunction with the patient. Given the benefits that access to care and treatment plans should bring patients with a mental disorder, it would be more than appropriate for informal patients to be included as well.

If anyone actually listened to what I said in the debate on our second day in Committee, they may be aware that I had some sympathy with the point made by the noble Baroness, Lady Murphy, who is not in her place. She argued that she did not want to extend the independent mental health advocates to informal patients, possibly because of resource constraints but also because of limited evidence on their therapeutic benefit. I could be accused of being inconsistent, but I would say that, for care and treatment plans, the issue is rather different.

The clinicians will draw up these plans. The Bill states that it is the “appropriate practitioner” who will already be treating that patient, so it may not be the same issue of resources. Perhaps it will take extra time, and I understand that time adds up the more you require of a clinician. But, given that the informally admitted patient will already be being treated by a clinician, we would not necessarily be adding much resource or burden on to the clinician, in the same way as if we had extended the IMHAs, as in the argument made the other night.

Therefore, I hope this amendment will extend provisions that will benefit informally admitted patients, as they will benefit the patients already decided upon in the Bill. I beg to move.

Baroness Browning Portrait Baroness Browning (Con)
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My Lords, I have added my name to this amendment. I will not detain the Committee long, but I support the amendment and I want to flag the point my noble friend made about Wales and England. To my certain knowledge, when people living further north around the Shropshire border, for example, are admitted, they will almost certainly be offered placements in north Wales. It is important that there is some harmony in these regions; otherwise, it will cause additional problems. I hope my noble friend will press his amendment in due course to make sure that that harmony exists.

Baroness Butler-Sloss Portrait Baroness Butler-Sloss (CB)
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My Lords, I will speak to Amendment 61. I recognise that the purpose of the Bill is to give children and those under 16 greater rights and opportunities to be heard. I entirely agree with that; it is absolutely sensible. But there is a danger of ignoring the fact that parents are basically not considered anywhere in the Bill. They are not in the contents of the Bill or any of the schedules.

Most parents are suitable; some parents are not. It may be that my amendment should perhaps be put in slightly different way, as the noble Baroness, Lady Berridge, has done. I recognise that there is a small percentage of parents who may not have total parental responsibility or, if they do have it, they are in the situation of one parent having what used to be called custody and the other having what used to be called access. For most parents, they care about their children. As far as I can see, they are completely ignored, but they do have something to contribute.

I am not suggesting for a moment that parents should make the decisions. What I am asking the Minister to do is to give them the chance to be heard; that is all I ask. They really should, throughout the Bill, be consulted where that is appropriate, but they are not put in for consultation, as far as I can see, in any part of the Bill. This is one place where that really will not do.

Speaking as a parent and grandparent, I would be extremely upset if my child was about to be detained and everybody was discussing what should happen to my child, but nobody asked me. At the moment, as far as I understand, the Government do not seem to think that parents, special guardians or anybody else who happens to have parental responsibility need to be consulted.

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Baroness Watkins of Tavistock Portrait Baroness Watkins of Tavistock (CB)
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My Lords, my amendment is very closely aligned to the amendment just moved by the noble Lord, Lord Kamall, but it is in relation to children. This is an issue that I raised at Second Reading. A number of children and young people are admitted to mental health settings informally on the basis of their own consent or parental consent—notwithstanding what was just said by the noble and learned Baroness, Lady Butler-Sloss.

Research from the Children’s Commissioner for England suggests that around one-third of in-patients aged under 18 are informal. However, NHS Digital does not publish data on the number of young people admitted informally so it is impossible to accurately track the total number of young people in hospital or to identify trends. Concerns have previously been raised, particularly by the Children and Young People’s Mental Health Coalition, that young people who are informal patients are often under exactly the same conditions as those who are detained but without access to the safeguards that children formally detained have. Many children and young people who are informal patients are also often unaware of their rights and, as has already been acknowledged, do not feel that their voices are listened to.

The coalition believes that it is crucial that informal patients aged under 18 have the same safeguards as those detained under the Act. There are two key provisions in the Mental Health Bill that can be strengthened to improve care for children and young people admitted informally. The most important, the coalition argues, is extending care and treatment plans to informal patients aged under 18, which is what my amendment is designed to do.

The reason for that is, if you manage to get somebody who is under 18 to accept informal care, they have no mental health formal record for their future. Most of us who have worked with young people under 18 bust a gut to get them to accept an in-patient admission if it is really necessary—I am talking about families as well as professionals—in order to ensure that they get treatment.

If that treatment is not guaranteed on discharge through a care and treatment plan, in the way that it would be for a detained patient, can your Lordships not see that families would be put in such difficult positions? They would ask, “Would it be better if my child is sectioned and detained in order for them to get long-term care?” This brings me back to my continued, impassioned plea that we need to think about proper standards of elective care for people with mental health problems, most importantly for those under 18.

Lord Davies of Brixton Portrait Lord Davies of Brixton (Lab)
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My Lords, I remind the Committee of my entry in the register of interests that I am on the advisory board of the Money and Mental Health Policy Institute. I mention this particularly because the three amendments in my name, dealing with the financial implications for people who struggle with their mental health, have been based on the work of the institute.

As I have reminded the House on many occasions, these amendments speak to the undeniable but all too often overlooked fact that our mental health and money are closely linked. When someone is hospitalised for a mental health crisis, bills still need to be paid and debts can mount up, resulting in financial difficulties that greatly damage people’s prospects of recovery.

It is worth focusing on the numbers. In 2022-23, almost 90,000 adults were admitted to hospital for a mental health problem. The Adult Psychiatric Morbidity Survey indicated that around one-quarter of people experiencing a mental health problem are also in problem debt. The rate of problem debt is undoubtedly higher among people experiencing a mental health problem, which leads to hospitalisation. An earlier study from 2008 found that one-third of all people with probable psychosis are in problem debt.

The three amendments dealing with the link between finance and mental health deal with different aspects of the problem, and they are, quite rightly, being considered in turn in relation to the relevant parts of the Bill. Today, we start with my Amendment 59, and I thank the noble Baronesses, Lady Tyler of Enfield and Lady Neuberger, for their support for it. Like the other amendments in this group, it deals with care and treatment plans. Later, we will come to the implications of advance choice documents, which is currently in group nine, and then provision for mental health crisis breathing space, which is currently in group 17.

The Mental Health Bill provides an important opportunity to tackle the vicious cycle of poor mental health often leading to financial problems, and financial problems often leading to poor mental health. We must break that cycle and ensure that people’s financial needs are addressed as part of a supported recovery from a mental health crisis. That focus is missing from the Bill in its current form, and my amendments seek to address that gap.

As I have already indicated, these amendments are informed and supported by the independent charity, the Money and Mental Health Policy Institute, which has done considerable and excellent work in this area. They are small changes designed to improve the Bill and the outcomes for those it aims to help, by ensuring that a person’s financial situation is routinely considered and acted on as part of their treatment and recovery from a mental health crisis. Addressing a person’s finances is one of the many factors that mental health practitioners must consider in their assessment and care planning.

However, services cannot rely on patients to tell them when they are facing financial difficulties. The experience is that people rarely take the initiative to tell mental health professionals about money problems, often because they are too unwell or because the stigma around both mental health and financial problems acts as a barrier to disclosure. Adding an explicit prompt about people’s financial situation in care and treatment plans will ensure that this is routinely and consistently considered by healthcare professionals and will open up more opportunities to safeguard patients from financial harm.

There is a precedent for this. In Wales, “finance and money” is already included as a section in the care and treatment plan template. That does not mean that busy healthcare professionals are required to support people with their money in a way that they are not trained or intended to do. Rather, this is a case of empowering them to identify those in need and refer them to the relevant welfare adviser in their service, so that healthcare professionals can focus on medical care. Ultimately, that could free up time for health professionals, as well as improving outcomes for patients.

I will illustrate the need for this proactive inquiry with testimony from someone with lived experience of money and mental health problems, as they do it so much more powerfully than I can. A participant in Money and Mental Health Policy Institute research shared:

“I didn’t realise how much my mental health affected my finances and vice versa. I lived for years in shame and horrific anxiety about money which caused my mental health to spiral. I thought there was no help out there for me and I didn’t want to be alive, as I couldn’t see a way out of my money troubles”.


Legislating to include a consideration of people’s finances, when they are in a mental health crisis and throughout their recovery, will help prevent further illness, support recovery and reduce waiting lists, and will help people return to daily life, including work, more smoothly.

I can imagine what my noble friend the Minister’s response will be, because she has already written to the institute. She said in her letter: “We intend to set out in secondary legislation the required contents of the statutory CTP. However, we plan to further consult stakeholders to make sure that the CTP covers all the information that is critical to an individual’s recovery and timely and effective discharge from the Act”. I hope that she does not mind me taking the opportunity to stress the importance of this issue. Does she agree with that, including the importance of its place in treatment plans?

Baroness Neuberger Portrait Baroness Neuberger (CB)
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My Lords, I will speak to Amendment 59, in the name of the noble Lord, Lord Davies of Brixton, to which I have added my name. I must declare rather a lot of interests. I am chair of the University College London Hospitals NHS Foundation Trust and of the Whittington Health NHS Trust, which provides child and adolescent mental health services. I was also one of the vice-chairs of the independent review of the Mental Health Act in 2018, which feels like a long time ago.

I am keeping my comments in Committee fairly short and sparse, because I feel that I have had quite a lot of say already, having been involved in that review. However, I want to speak about the issue of financial difficulties and mental health problems, because we should have looked at it in greater detail when we were conducting the review. It was an omission on our part, as we did not focus on it in any detail. The noble Baroness, Lady Barker, cited one of the people who spoke incredibly movingly to our review and who talked about how awful it is to be an in-patient. She said that she recovered and was given the care she needed, but she asked why it had to be such an awful experience.

One of the things that is becoming clearer—the noble Lord, Lord Davies, alluded to it—is that when you have had a mental health crisis and your finances are in an absolute mess, because you did not get it together to do anything about them, why does your recovery have to be so awful because nobody helped you and gave you the advice you needed at the time? That is why this is so serious. If you are in hospital, you may not even get access to your computer, you may not be using your mobile phone all the time, you may be in something of a mess and your cognition may be severely affected. If that is the case, you will not be paying your bills, claiming your benefits or paying your rent. When you recover, it will take you ages to get into a situation where you can live a normal life again and not be hugely in debt.

I was going to cite some of the experts by experience—the quotations have been given to me by the amazing Money and Mental Health Policy Institute, to which I am extremely grateful. However, since I do not want to take much more of your Lordships’ time, I shall just say that, although NICE stipulates that assessments in care and crisis plans at present should consider patients’ holistic social and living circumstances, which would include things such as housing and finance, mostly, in normal circumstances, the issues are too great. Often, the mental health needs are at crisis point and it just does not happen, and the same will happen with care and treatment plans unless we put this in the Bill.

I ask the Minister—I have already heard what the noble Lord, Lord Davies, has said—whether she will think quite hard as to whether this could be in the Bill, along with parental involvement. I agree with all the amendments in this group. There are some things that need to be in the Bill that would make sure that, when we see treatment in place—and I see a lot of it in what I do in the other part of my life—those things are taken into account. If it is in secondary legislation, it is much harder and much less likely.

House resumed. Committee to begin again not before 8.10 pm.

UK-Ukraine 100-year Partnership

Wednesday 22nd January 2025

(1 day, 2 hours ago)

Lords Chamber
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Statement
The following Statement was made in the House of Commons on Monday 20 January.
“With permission, Mr Speaker, I will now make a Statement on Ukraine. Last week, my right honourable and learned friend the Prime Minister visited Kyiv. It was his seventh meeting with President Zelensky, but this visit had a special purpose: to sign a historic 100-year partnership with Ukraine. The partnership enshrines both sides’ commitment to a relationship benefiting the whole of our nations: businesses as well as the Government, communities as well as our military. It consists of a legally binding treaty and a political agreement outlining our co-operation in greater detail. We will lay the treaty before this House for scrutiny in the usual way.
The partnership covers the full breadth of our friendship, across nine pillars. In each area, deeper co-operation can enhance our collective security and help us both to build resilient, flourishing economies. On maritime security, through joint exercises and training between the Royal Navy and the Ukrainian navy, we can enhance their effectiveness and learn from their successes in securing the Black Sea. On air defence, the supply of 15 Gravehawk missile systems, produced in Yorkshire by BAE Systems, is a direct benefit to our economy and an innovative new capability for Ukraine. On the energy sector, the agreement cements the United Kingdom as Ukraine’s preferred partner, opening up opportunities for us and them in areas such as renewables and green steel.
The Prime Minister saw at first hand what our work together can mean for the people of Ukraine, while visiting a burns unit supported by specialist National Health Service doctors, helping them to treat victims of indiscriminate Russian attacks and joining a Ukrainian class speaking to a primary school in Liverpool. It is these young people who will reap the rewards of the efforts we are making today.
A partnership lasting 100 years, beyond the lifetime of even the youngest Members of this House, is unprecedented, but it reflects the unique nature of our friendship—a friendship that Members on all sides did so much to strengthen. I pay particular tribute to the work of my predecessors the right honourable Member for Braintree, Mr Cleverly, the noble Lord, Lord Cameron of Chipping Norton, and the former Member for Welwyn Hatfield for their work under the previous Government in supporting this partnership.
This cross-party unity is a source of strength for our country and a source of strength for Ukraine. It is a unity that goes well beyond this House. Members will have witnessed it in their constituencies, from the more than 200,000 Ukrainians who have found refuge in our homes to the countless Ukrainian flags flying proudly outside churches and town halls across the country.
This Government have shown strong support for Ukraine since our first day in office. For my part, I have called out Putin’s modern-day imperialism in the United Nations Security Council, I have been using the full force of our sanctions against Putin’s war machine, with the UK having led the way in sanctioning Putin’s shadow fleet, and I announced over £600 million in humanitarian and fiscal support during my own visit to Kyiv in September. My ministerial colleagues have been playing their full part as well. My right honourable friend the Secretary of State for Defence has accelerated the delivery of military aid, extended our training of Ukrainian soldiers to at least the end of the year and signed a defence industrial treaty with Ukraine, allowing it to draw on £3.5 billion of UK export finance to acquire military equipment. This month, legislation introduced by my right honourable friend the Chancellor came into force, enabling a loan of over £2 billion more to Ukraine, all of it repaid through the use of profits from frozen Russian assets. That funding comes on top of the Government’s commitment, made by the Prime Minister in our first week in office, to provide £3 billion a year in military aid in every year that it is needed. We do not know for how long it will be needed; it is for Ukraine to decide at what point and in what way to have any form of talks with Russia, and Ukraine will continue to need support from its friends even after Putin’s barbaric, illegal war comes to an end. We have always said that we want to see a just and lasting peace, but our priority right now, together with our allies, is to put Ukraine in the strongest possible position to achieve that.
Three things are clear. First, Ukrainians want to live at peace with their neighbour. They did not provoke this war, whatever the false claims of the Kremlin or its army of bots online, but now that Putin’s mafia state is preying on them, they are fighting back courageously. Their cause is just: quite simply, the freedom to choose their own future. Secondly, Putin shows no sign of wanting peace. He could end this war tomorrow by withdrawing from Ukraine, yet he insists that the war will not end until he has achieved his objectives—objectives that amount to the subjugation of the Ukrainian people. That is no basis for meaningful dialogue, and Putin’s actions speak far louder than his twisted words: inhuman strikes on civilians on Christmas Day, dispatching North Korean troops to the frontline, and wave after wave of attacks on the brave people of Ukraine.
Finally, Putin’s position is not one of strength. The invasion has been a monumental strategic failure, and pressure is mounting. Russia’s casualty rate is staggering, the highest number of military casualties that the country has suffered since the Second World War, and Russia is more insecure than it was before the war—and for what? Russia gained some territory last year, yes: fields and small settlements, left barren by relentless bombardment, and taken at a rate so slow that the Russians would need a century to conquer all of Ukraine. Meanwhile, their economy struggles increasingly to sustain the war through this year alone. Spiralling inflation is making basic goods such as butter unaffordable, welfare cuts are hitting the most vulnerable, and interest rates have been hiked to a record 21%. We are approaching the third anniversary of this conflict, and, as the Prime Minister said in Kyiv, we must not let up now. Putin hopes that the world lacks his resolve, and we need to call his bluff to prove him wrong.
This is not simply a moral necessity, although I know that the whole House has moral clarity on the righteousness of supporting Ukraine. It is also a strategic necessity for Britain and our allies. If Putin wins in Ukraine, the post-war order founded in great part by my predecessor Ernie Bevin, which has kept us all safe for more than eight decades, will be seriously undermined. Foundational principles of sovereignty and territorial integrity will be shaken, and a more dangerous world will result. That is why the Government will not falter, it is why the Prime Minister travelled to Kyiv, and it is why we stand firmly with Ukraine, today, tomorrow, and for generations to come. I commend this Statement to the House”.
19:31
Lord Callanan Portrait Lord Callanan (Con)
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My Lords, for nearly three years now, we have been steadfast and united in our unwavering support for the brave people of Ukraine. Their extraordinary determination, unparalleled courage and steadfast bravery in the face of unimaginable horror, terror and brutality have inspired nations across the globe. It is impossible not to feel profound sorrow for the pain, loss and suffering inflicted on the Ukrainian people by Putin’s illegal and barbaric war. This unprovoked invasion of a sovereign nation is not just an attack on Ukraine but an assault on the principles of sovereignty and human rights that underpin global peace and security.

I am delighted to say that, from the very beginning of this crisis, we in the UK have stood shoulder to shoulder with President Zelensky and the Ukrainian people in their valiant fight for freedom. We recognised early on the grave threats posed by Russian hostility, which began with the illegal annexation of Crimea in 2014 and continued with ongoing incursions in Ukraine’s eastern territories. The previous Government took decisive and swift action, providing vital military equipment, financial aid and humanitarian support—and I am delighted to see that the current Government have continued that policy. We established bespoke pathways to safety for Ukrainians seeking refuge in the United Kingdom, and I am proud to note the extraordinary response of the British people. Across the country, households opened their doors and their hearts, welcoming those fleeing violence and oppression. This collective effort has been a testament to the strength of our shared humanity and values.

Through the leadership of Boris Johnson, Liz Truss, Rishi Sunak, Ben Wallace and others, the UK spearheaded diplomatic efforts to galvanise international support for Ukraine and helped to isolate Russia on the global stage. Those efforts included imposing one of the most comprehensive sanctions regimes ever implemented, targeting not only the Russian state but its ruling elites, businesses and entities complicit in supporting the Russian war machine. The commitment to Ukraine’s sovereignty and territorial integrity was unshakeable. Over three years, we provided £12.8 billion-worth of support, including an unprecedented £7.8 billion in military assistance. This support encompassed advanced weaponry, vital training and intelligence-sharing to enable Ukraine to defend itself against Russian aggression. Equally crucial was our promise to provide at least £3 billion annually in military aid for as long as is required—a pledge that I hope that the Government will be able to continue with, without hesitation.

As we reflect on these achievements, it is imperative that we remain steadfast in our support for Ukraine and its people. The road ahead will not be easy, given Trump’s election, and the sacrifices that will be required are considerable. However, the cost of inaction—of failing to defend freedom and democracy—would be immeasurably greater. I want therefore to pose the following questions to the Minister.

Can the Government provide an update on the current levels of military and humanitarian aid being delivered to Ukraine and how they see this support continuing in future? What steps are being taken to ensure that sanctions against Russia remain robust, effective and tightly enforced, including measures to address any potential evasion? How are the Government working with international partners to ensure that Ukraine continues to receive the long-term economic and political support that it needs to rebuild and secure its future? What plans are in place to enhance the UK’s refugee resettlement schemes for Ukrainians, and how can we further support host families who have welcomed those fleeing this terrible conflict? Finally, in the context of ongoing geopolitical instability, how do the Government intend to strengthen and deepen the UK-Ukraine partnership to promote shared values and mutual security in the years ahead?

We owe it to the people of Ukraine, and to the principles of freedom and justice that unite us, to stand resolute and united in their hour of need.

Lord Purvis of Tweed Portrait Lord Purvis of Tweed (LD)
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My Lords, I am very happy to align myself and these Benches with everything that the noble Lord, Lord Callanan, has said. If we think back over this three-year period in British politics, we see that consensus has been hard to reach—but this is an area where there has been no division between any of the Benches within the two Houses of our Parliament. Indeed, in respect of the position of the previous Administration and this one, this agreement brings together both government-to-government relations, or the nine pillars within the agreement, and people-to-people relations, which, as the noble Lord said, are becoming ever deeper.

I also agree with the noble Lord’s observations on the coming period, when there will be an area of uncertainty, especially since the new President was elected in the United States, in the context of our main ally being the United States. But I am happy that UK policy is set by the UK and that the consensus in Parliament is therefore rock solid.

A 100-year agreement is unique. I looked at what Ukraine was like in 1925—and when you search for that, Ukrainisation comes up as the top element. There were attempts to ensure that the identity, language, culture and literature of Ukraine were protected. That was diminished under later Soviet rule—but to my mind that suggests that, whether it is with Stalin or Putin, there is an identity for an independent and autonomous people in Ukraine who wish to ensure that their own destiny is in their hands. The UK will be a stalwart ally over this Government and their successor Governments. While this is unique for being a 100-year agreement, we support it.

We support in particular the areas where we would use what are to some extent our best global assets, on renewable technology, the National Health Service, education and culture. The partnership with Ukraine within those pillars is to be welcomed. Can the Minister say, when it comes particularly to energy, renewables and green steel, whether the Government will be open to ensuring that all parts of the UK, especially our devolved Administrations, are deeply involved in this 100-year agreement? I live in Scotland, and the people of Scotland have opened their hearts and homes to those who have fled Putin’s illegal war—but we also have strategic advantage, especially when it comes to renewable energy and technology.

Economic and technical support will be incredibly important. As we debated just last week, one consequence of the illegal war on Ukraine is that 40% of the Ukrainian economy is now dedicated to defending itself. Technical support and partnership with the UK for economic reconstruction will be to the advantage of both countries. The Minister will have been briefed on assets, because we debated them fairly recently. She will be aware that these Benches are making the case that assets should be seized and used for the immediate and medium-term reconstruction of Ukraine, as well as for Ukraine’s ability to defend itself. If she could outline a bit more the timetable of when Ukraine will, we hope, be able to use some of the assets that we approved in legislation last week, that would be helpful.

I end with an appeal and an observation. The appeal is that one of the elements that I have found very important in Ukraine’s defence is the Verkhovna Rada—the Ukrainian Parliament. I had the privilege of visiting it before the war on three occasions and met many MPs and staff. It was telling that one of the first military objectives of the Russian assault on Ukraine was, within the first 48 hours, to seize the Verkhovna Rada, to cease its functioning, to ensure that MPs could not carry out their constitutional role in representing the people and to stop all legislation. It has carried on and shown incredible resilience. As a Parliament, it is a model around the world for being able to carry on its legislative and representative functions in incredibly difficult circumstances.

I hope the long-term relationship will be not just Government to Government but Parliament to Parliament. I know Mr Speaker and the Lord Speaker have extremely close relations with their counterparts in Kyiv, but I hope the Minister might be able to say that in those areas that the Government fund, whether the Westminster Foundation for Democracy or other technical assistance, we can support the Verkhovna Rada in carrying out its functions and the critical role it will play to ensure that any reconstruction is open, transparent and representative.

I close by repeating the words of my honourable friend Calum Miller. He said to the Foreign Secretary:

“We must stand with Ukraine for the long haul. The Ukrainian people must be in charge of their own destiny. If the UK’s new pledge is to be real, it must address the uncertainty generated by President Trump. The Prime Minister’s 100-year commitment must outlast the President’s desire for a quick deal in his first 100 days”.—[Official Report, Commons, 20/1/25; col. 738.]


I am certain that the Government’s intent is one we can support wholeheartedly. I would be grateful if the Minister would outline certain areas where we can use this as not just a statement of intent but a practical relationship that can help Ukraine be both resilient in war and successful in peace.

Baroness Chapman of Darlington Portrait The Parliamentary Under-Secretary of State, Foreign, Commonwealth and Development Office (Baroness Chapman of Darlington) (Lab)
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My Lords, I am incredibly grateful for the words of the noble Lords, Lord Callanan and Lord Purvis of Tweed. As they both said, it is so important that we commit ourselves to maintaining the unity that we have held so clearly for the three years that Ukraine has been experiencing the illegal invasion.

It is right that I pay tribute to the work of the previous Conservative Government—the Prime Ministers, Foreign Secretaries and Secretaries of State for Defence who worked so hard to support Ukraine during their time in office. I am grateful that the noble Lord, Lord Callanan, made that point. I am happy to agree with him and I thank him for the support that his party is providing in opposition to this Government. I also echo his comment about the people of the United Kingdom who, as he said, have been welcoming and, in many cases, hosting families from Ukraine in their homes. The support in our communities up and down the country remains as firm as it has ever been. I am happy to assure him that we will keep the commitment to £3 billion a year for as long as it takes to support Ukraine in its defence.

The noble Lord asked for an update on spending on military and humanitarian work. As I think I have said before, there is £7.8 billion of total support, including £3 billion for 2024-25. We have a commitment to provide £3 billion per year until 2030-31, and for as long as it takes, and for the UK to contribute £2.26 billion to the $50 billion of extraordinary revenue acceleration loans for Ukraine agreed by G7 leaders in June. The Government have laid legislation to facilitate disbursement. On humanitarian aid, the UK is providing at least £120 million in humanitarian assistance through to the end of financial year 2024-25, bringing our total contribution to Ukraine and the region to £477 million since the start of the full-scale invasion. Another £15 million delivered through UNHCR and UNICEF will support those most in need this winter.

The noble Lord, Lord Purvis of Tweed, asked about those from Ukraine living here and their status. Obviously, this is a matter for the Home Office, but we are all glad that their status has been renewed and that their ability to stay here is now secure for the time being. I am sometimes asked what this will mean in the longer term. I am very mindful of the words of President Zelensky, when he said that he wanted people to be able to go home. We do not want to compound Ukraine’s problems by keeping people here when they can be at home in Ukraine, contributing to the rebuilding of their community and their country.

I was very grateful to the noble Lord, Lord Purvis of Tweed, for highlighting pillar 9 of the agreement on the people-to-people work. This is so important for morale in Ukraine and it will be vital as we move forward in the years and decades to come. He also raised the very important point—Speaker Hoyle will be glad that he did—about Parliament-to-Parliament work and rebuilding democratic structures and institutions. Speaker diplomacy is underpriced when we consider this work, and I know there will be much to be done and said, and links to be forged. It is wonderful to have his support in that. He is right too to remind us of history and to look back at 1925: that is an interesting thing to do. Let us just hope that the partnership we are agreeing between our countries today means that, in 100 years’ time, we can look back and see what was agreed in 2025 as a turning point for Ukraine, having endured so much.

The noble Lord also raised questions about climate and energy. This is vital and is covered in pillar 5 of the agreement. He is absolutely right—and I am as passionate as he is about this—that we must enable our regions and nations fully to take part in this work. It is vital that we do that.

The noble Lord also asked about assets. As he will know, we put into law an agreement enabling us to use the profits from seized Russian assets, but he will also understand that we have to proceed carefully. We are very actively discussing all this and want to make sure that we can do everything we can in this regard. Those discussions are very much live within government, I can promise him that.

To conclude, I thank both Front-Bench speakers once again for their continued support for Ukraine.

19:49
Lord Lancaster of Kimbolton Portrait Lord Lancaster of Kimbolton (Con)
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My Lords, to date, the UK has given £7.8 billion-worth of military assistance to Ukraine and that has been paid for from the Treasury reserve. Under this agreement, we commit to give a further £3 billion per year until 2030. Can the Minister say whether that will continue to be paid for from the Treasury reserve, or will it, as some fear, be transferred to the defence budget, because without the appropriate baselining that would effectively negate any increase in the defence budget to 2.5%?

Baroness Chapman of Darlington Portrait Baroness Chapman of Darlington (Lab)
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I thank the noble Lord, Lord Lancaster, for his steadfast support and championing of the need to have sufficient resources for the MoD; I have seen him do this on many occasions. Of course, this will be subject to discussion between the Treasury and the MoD, and my understanding is that it will be allowed for within the MoD budget. We will make sure at every stage that our troops have everything that they need. We are committed to the 2.5%, and we are committed to providing the £3 billion per year to Ukraine.

Lord Bishop of Manchester Portrait The Lord Bishop of Manchester
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My Lords, I hope the thin attendance tonight does not mean that we in the United Kingdom are losing interest in Ukraine, especially when I think of the huge number that gathered in Westminster Hall when President Zelensky came and spoke to us, and when many of us went across and sat in the Gallery in the other place when he spoke on a Zoom-type link in the early days of the conflict.

It is my privilege, as the Bishop of Manchester, to regularly attend social functions at the Ukrainian Cultural Centre, which is only about a mile away from my home. We have had a strong Ukrainian community in Manchester since the Second World War, if not before. That has been greatly increased in recent times, by those who have come as refugees. I share the comments that others have already made about hoping that many of those people will want to go back and rebuild their countries.

We are talking about friendship and a 100-year friendship at that, but a partnership has to be built on more than just defence spending or mutual hatred of a common enemy; it needs to be about building connections at every level. I am pleased to hear what was said about parliamentary connections, but I am thinking in terms of the church connections that I build with my friends in the Ukrainian Catholic Church. What other civil society connections can we strengthen and grow if this friendship or partnership really is to last and be of benefit not only to the people of Ukraine but to this country as well?

Baroness Chapman of Darlington Portrait Baroness Chapman of Darlington (Lab)
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First, I think the lack of attendance this evening is probably something to do with a couple of late nights of voting. It is not lack of support at all; it is a lack of disagreement between our parties. If we disagreed, this place would be full, and the fact that we agree so strongly means that noble Lords feel confident in all Front Benches being here and saying things with which they would agree.

I am so glad that the issue of people-to-people links is featuring so much in this discussion. It is true that this cannot only be Government to Government or Parliament to Parliament; it needs to encompass the whole of civil society. We are speaking to the British Council, the Premier League and many other organisations so that there is a real depth to that partnership, under pillar 9 in the agreement, which is something we feel passionately about. I know that Members from across the House will want to bring their contacts, expertise and experience to contribute to making pillar 9 as deep and meaningful as we can.

Baroness Helic Portrait Baroness Helic (Con)
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My Lords, I welcome the Government’s clarity on the moral and strategic necessity of supporting Ukraine, and the House’s full support—from those who are here—for the future of Ukraine, and what both we and the Government have done previously. But the West’s longstanding appeasement of Russia, from Moldova to Georgia to Crimea, emboldened Russia’s full-scale invasion of Ukraine. A pre-emptive and timely response would have been far less costly in lives and resources than addressing the aftermath. However, we are where we are. We now risk repeating the same mistakes in the western Balkans. Sadly, today’s Serbia mirrors Russia’s 2014 trajectory, engaging in large-scale rearmament and actively backing secessionists in Bosnia and Kosovo. With that in mind, can the Minister say what concrete steps the Government have taken in the western Balkans not to have the Ukraine scenario repeated there? Can she clarify the Government’s position on rejoining Operation Althea?

Baroness Chapman of Darlington Portrait Baroness Chapman of Darlington (Lab)
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I thank the noble Baroness for reminding us of the wider context—it is very important—as well as reminding us of the not-too-distant history of this conflict. I can assure her that my honourable friend, Minister Stephen Doughty, is in regular contact with our friends and allies in the Balkans, and he is working very hard to prevent the situation that she warns us of. It is right that we do not take our eye off the situation which she discusses.

Lord Lancaster of Kimbolton Portrait Lord Lancaster of Kimbolton (Con)
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With your Lordships’ indulgence, I will ask one more question since we have lots of time. I want to pick up on a point that the Minister made in her initial response about the status of refugees in the United Kingdom. I declare an interest in that my wife, Caroline Dinenage, the MP for Gosport, and I have hosted a Ukrainian family for the last two and a half years. They are very happy here and are pleased that there is clarity that, with their initial visa due to end shortly, they will be allowed to apply for a further 18-month extension, which, of course, takes them to four and a half years—some six months shy of the five years required to apply for indefinite leave to remain. Notwithstanding the Minister’s comments about not wishing to hold them here, the brutal reality is that they have made their home here and they wish to stay. They do not wish to go back to Ukraine because they simply do not have anything to go back to. While I realise the Minister cannot commit as to their status, will she perhaps take this opportunity to say that the one thing the Government will not be doing is forcing people to go back to Ukraine?

Baroness Chapman of Darlington Portrait Baroness Chapman of Darlington (Lab)
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First, I acknowledge that the noble Lord and Caroline have done so much to support a family from Ukraine. Although many families are doing this, it is still an exceptional act of generosity and welcome. It is truly something we should acknowledge and thank him and Caroline for. I respect that he has taken this opportunity to raise this issue and highlight the feelings and thoughts of some people who are here from Ukraine who may feel as he describes. Clearly, this would be a matter for the Home Office at the point at which their status comes up for renewal again. I would not want to prejudge what the Home Office might decide, but he has made the case very strongly and clearly, and I am sure that that will be heard by colleagues at the Home Office.

19:57
Sitting suspended.

Mental Health Bill [HL]

Wednesday 22nd January 2025

(1 day, 2 hours ago)

Lords Chamber
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Committee (3rd Day) (Continued)
20:10
Clause 20: Care and treatment plans
Debate on Amendment 57 resumed.
Baroness Barker Portrait Baroness Barker (LD)
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My Lords, I will speak briefly to Amendment 60A. At this time of night, I do not intend to make a very long or detailed speech; I simply wish to make two points. Previous speakers, such as the noble Lord, Lord Davies of Brixton, talked about factors that should be included in care and treatment plans and often are not, for a variety of reasons. But they are crucially and directly important to the health and well-being of an individual.

I wish to talk about the inclusion of housing, for two reasons. First, housing is a source of anguish and mental strain, full stop. It does not matter whether people have mental health problems, but if they have and they find themselves in an acute hospital, either detained or as a voluntary patient, I am sure that, when they come back, there will be a very high incidence of them losing their tenancy and then being unable to find suitable accommodation, particularly if they are young.

Members of your Lordships’ House have already spoken about the fact that there are very few treatment centres dotted around the country for young people with eating disorders—here in the Bill we are talking about England. That therefore means that young people are having to go very long distances for treatment, which can have a significant disruptive effect on their living circumstances.

The other reason I thought it was worthwhile to table this amendment and have the debate was that the other day, we had a wider debate about care and treatment plans. The one question many of us were trying to ascertain the answer to was: who is responsible for them? Who is responsible for drawing them up and implementing them? Crucially, who is responsible if they are not implemented and there is a consequence to that for an individual? If we cannot focus our minds on that now, given what has been going on in the country, we never will. The only thing I could take away from our discussion the other day was that nobody is responsible for it at all; nobody is going to carry the can.

When we are talking about people who have been in acute care, very little attention is paid to their housing needs, because that is not the duty of that service provider, whose focus is on acute care. We know that local authorities are already required to provide aftercare and advice to individuals, but advice in the face of a bailiff turfing you out of your house is frankly of limited use. So, I would like the Minister to please consider this amendment and give assurances that, when we ever get to the bottom of who is responsible for these care and treatment plans, this is on the list of things for which they can be held accountable.

20:15
Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD)
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My Lords, I will speak to Amendment 62 in this group, which is in my name, and I will try to be as brief as possible. This group is all about the statutory care and treatment plans, and I very much welcome them. They are a very positive part of this legislation and should help patients achieve recovery and hopefully discharge from mental health in-patient units as quickly as possible.

My amendment seeks to ensure that individuals who are turning 18 during a care and treatment plan have their plans reviewed to ensure that there is continuity of care when transitioning from child to adult services. I spoke earlier about the tricky issue of transitioning from child to adult services. It is important for three reasons. Young people aged 16 to 25 experience high rates of mental health problems but are less likely to access the support they need; young people often experience tricky transitions, meaning that too often they fall through the gaps—we have heard so many stories about in this Chamber in the past; and, again as we have said earlier today, young people really should have a say in their care and treatment.

We know that there is a high level of mental health need among young people in the 16 to 25 age group and that it is going up. I have no wish to return to the earlier debate about whether that rise is real, but the numbers according to NHS Digital are very much on the increase. So, while 16 to 25 year-olds are experiencing high levels of need, they are often having real difficulties accessing support. It is sometimes talked about as the treatment gap, which is what the noble Lord, Lord Stevens, talked about earlier on, and it is far wider here than for other age groups.

These poor transitions between CAMHS and adult services are generally the problem because, after someone reaches their 18th birthday—which is the upper limit for CAMHS—young people too often face a real cliff edge when trying to access mental health support. They are no longer in the age range for CAMHS and simultaneously may not reach the threshold for adult services. Effectively, it leaves young people in limbo, with no access to the mental health support they require.

There is a range of reasons for these challenges, including poor information and, very importantly, a difference in treatment models. While children’s services are generally seen as more nurturing, with a focus on treating developmental and emotional disorders, adult services in contrast focus on treating severe and enduring mental illness, meaning that young people with these diagnoses are less likely to be accepted. Just as I have mentioned, the high thresholds for support often result in young people being told that they are not ill enough for the services they need, so unfortunately things get worse and they end up being detained. Without that support during transition, young people can experience all sorts of worsening symptoms and other life outcomes. That is the rationale behind my Amendment 62.

I will mention another couple of amendments in this group that have my strong support. Amendment 64, in the name of the noble Baroness, Lady Keeley, from whom we have still to hear, really emphasises the critical importance of ensuring that, where young carers are involved in a family situation, they are identified, particularly by adult mental health practitioners, who may not have them in mind first and foremost, that people proactively look for them, and then that the young carers—who are often hidden, with their needs only identified when there is a crisis—are supported. That amendment has my full support.

Lastly, I support Amendment 59, in the name of the noble Lord, Lord Davies. At this point—because I have not done it yet—I refer to my interests in the register, both as a member of the Financial Inclusion Commission and president of the Money Advice Trust. I absolutely support what the noble Lord said about the importance of these plans, including matters to do with finance. The links between money problems and mental health are now well proven and this legislation should reflect them. The Bill provides a once-in-a-generation opportunity to ensure that people’s holistic needs, including finances, are considered as a key part of supporting recovery from a mental health crisis.

Baroness Keeley Portrait Baroness Keeley (Lab)
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My Lords, I rise to explain the significance of Amendment 64 in my name, which aims to cover the situation of both young carers and young children in a family where a care and treatment plan is being prepared for their parent. I thank the Carers Trust for suggesting this amendment and providing a briefing on this issue. I also thank the noble Lord, Lord Young of Cookham, for his support for the amendment and, of course, the noble Baroness, Lady Tyler, who has just spoken of her support for it.

Briefly, the amendment adds the requirement that a practitioner preparing or reviewing a care and treatment plan must ask whether there are children in the family and take actions to respond if the children need help or protection from harm. This amendment would, as I said, cover young carers, but it would also cover young children where there may be safeguarding concerns—a topic which the Child Safeguarding Practice Review Panel highlighted as a theme in its latest annual report.

As the noble Baroness, Lady Tyler, just touched on, young carers are so often hidden, and often their needs are identified only when there is a crisis. Even then, the extent of their caring role and the impact it has on the child’s development may not be recognised quickly or fully assessed. This amendment would help to ensure earlier identification of children who might be in need of information, support or protection from potential harm. It would mean staff asking the right questions early on to ensure that the right information is recorded and actions taken. It would help with adequate signposting of information and a chance to offer appropriate support to avoid a crisis or manage it appropriately.

The amendment also mirrors the new wording in the Working Together to Safeguard Children statutory guidance, which covers adult social practitioners:

“When staff are providing services to adults, they should ask whether there are children in the family and take actions to respond if the children need help or protection from harm. Additional parenting support could be particularly needed where the adults have mental health problems”.


There is evidence that having a parent with a mental health problem is one of the biggest risk factors for a first episode of major depressive disorder in children and adolescents.

This is not inevitable. Research suggests that intervention can enhance parenting skills in households affected by parental depression, and it can change the way that children cope. In turn, this can reduce the risk of children internalising problems that may threaten their life chances. The amendment is designed to enhance the ability of agencies working individually and together to identify and respond to the safeguarding needs of families. It is about supporting the challenging work of finding out what is happening to children and anticipating risks and harm, of knowing when action is needed. In most cases, children receive the support, help and protection they need, but sometimes children are seriously harmed or, worse, they can die because of neglect.

Policy initiatives in recent years have called for a wider family focus on safeguarding children so that all staff recognise that meeting the needs of family members who may put children at risk benefits the child, the adult and the family as a whole. This amendment would support those efforts. The amendment is in keeping with guidance from the Social Care Institute for Excellence to “Think child, think parent, think family”, to ensure that the child is heard and their needs are met.

The Carers Trust believes that the amendment would unlock additional support from mental health professionals to work with parents and children to enable the child to have age-appropriate understanding of what is happening to their parent and information about what services are available for them in their situation and how they can access them.

To illustrate the need for the amendment, I have two short case studies. Aidan was four when his mother was first sectioned under the Mental Health Act. Throughout his childhood, Aidan’s mother was regularly sectioned and would sometimes be in hospital for a number of months. There were many occasions when the police were involved because his mother had disappeared, which was particularly scary for Aidan. In his words:

“To me, you only ever saw the police if you’d done something wrong, so I remember when they turned up at our house, I thought mum was in trouble”.


Seeing his mother being taken into hospital on a regular basis meant that Aidan had lots of questions and worries. In his words again:

“There were so many times where I wondered whether mum would ever come home. I knew she’d been sectioned but I had no idea what that actually meant or if she would ever get better”.


Staff at the hospital who were treating Aidan’s mother would regularly see him visiting. Despite this, none of the staff there told Aidan or his father about support that might be available or asked whether Aidan might need any help. It was only when Aidan was 12 and his attendance dropped at school that he was identified as a young carer.

The second case is Vamp’s story. This is a pseudonym chosen by her family. The case study is taken from a recently published child safeguarding practice review which found that a 13 year-old girl died as a result of taking drugs sold to her in a park. It was identified that her mother had had a period of serious mental illness, and that illness was identified as the catalyst for things deteriorating for the young person. Tragically, two years on, the young person had died. This is taken from the relevant extract from the child safeguarding practice review:

“Vamp’s mother did not feel that her daughter had been a young carer … as the mental illness was short term. However, Vamp’s sister described the situation as being so difficult for both. When their mother was discharged home from hospital, it was only Vamp and her mother at home. Vamp’s sister was only a young adult, and with her own baby to care for. She … said she felt that no one checked in on their mother. Vamp’s sister … said that professionals expected her mother to manage to parent Vamp, which she was not able to do alone, she needed professional help”.


This is a simple but important amendment to protect young carers. I urge my noble friend the Minister to consider it, and I commend the amendment to the House.

Lord Young of Cookham Portrait Lord Young of Cookham (Con)
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My Lords, I have added my name to Amendment 64, in the name of the noble Baroness, Lady Keeley, and shall speak briefly in support. I have not contributed to this Bill before, but I have sat through many of the debates. Without sounding pompous, it struck me that this was our House at its best, dealing with a complicated Bill in a sensitive and non-partisan way and drawing on the unique expertise we have in our House.

As I listened to the earlier debates on detention and community treatment orders, I asked myself how the children in the families concerned would be informed and what the impact on them would be. We have just heard from the noble Baroness, Lady Keeley, the impact on Aidan when his mother was sectioned. By definition, the people covered by the Bill are vulnerable people; many of them will have carers, and many of those carers will be young carers. As the noble Baroness has just said, this amendment simply helps improve the earlier identification of children of parents being detained under the Act and to ensure that they have access to support, if they need it, and are safeguarded where necessary.

The 2021 census showed that there are 50,000 young carers caring for over 50 hours a week. An astonishing number—3,000 of them—are aged between five and nine. The Carers Trust has shown that those young carers at school are at risk of a poorer attendance record, lower academic achievement and more liable to social isolation and, sadly, bullying, if they are not identified early. As the noble Baroness, Lady Keeley, just said, having a parent with a mental health problem is actually one of the biggest risk factors for depression in children and adolescents. But it is not inevitable: research suggests that intervention can reduce that risk and change the way that children cope.

As a vice-chairman of the APPG on Young Carers, I know that we took evidence last year from young carers, and we heard that on average it takes three years for a young carer to be identified, with some of them taking over 10 years before being identified. Improving early identification is one of the top priorities of the all-party group, so that they can access support and not be negatively affected by their caring situation.

This amendment will help to tackle the issue, which is reported by young carer services, that many potential young carers are not identified by adult mental health services. For example, one young carers service, the Young Carers Alliance, reported that 20% of the young carers it supports are supporting a parent with a mental illness, yet they did not receive a single referral from the adult mental health services in the space of an entire year.

In our inquiry, we also heard from the charity Our Time how, when it comes to identifying young carers by mental health professionals, we are way behind countries such as the Netherlands and Norway. Both those countries have introduced requirements for health professionals to consider whether adults with mental health problems have children. This referral may not be a one-way process; if the child is a carer, he or she may have an insight into the events that trigger an episode in the parent and may actually help the professionals to identify an appropriate treatment pathway.

A final benefit of this amendment is that it would help adult mental health in-patient units ensure that they are complying with the duty under Section 91 of the Health and Care Act 2022 to consult with any carers, including young carers, before discharging an adult from hospital. Again, last year, we heard of patients being discharged without the young carer being informed, often where they were the principal carer. For these reasons, I hope that the Government can support this amendment. I look forward to the Minister’s reply.

20:30
Baroness Berridge Portrait Baroness Berridge (Con)
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My Lords, I add my support for Amendment 58, tabled by the noble Baroness, Lady Watkins, and to which I have added my name. Briefly, given the time, the care and treatment plan is a major plank, a pivotal safeguard of the Bill. The safeguard is not open to voluntary patients. As the noble Baroness outlined, we want to encourage many young people to voluntarily enter a hospital to get the treatment that they need. A 2021 UCL research project found that only 23.6% of young people were detained involuntarily. The large cohort would be those who have consented by parental consent and those who voluntarily entered the treatment. As such a high proportion of the under-18 population are entering voluntarily, it is imperative that they also have a care and treatment plan.

Baroness Merron Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
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My Lords, I thank noble Lords for the pertinent points that they have made.

I will start with Amendments 57 and 58. There is no doubt that all patients who are in a mental health hospital for care and treatment should have a care plan, whether or not they have been detained under the Act. This is already set out in guidance for commissioners and in the NHS England service specification and care standards for children’s and young people’s services. In line with the independent review’s findings and recommendations, care and treatment plans for involuntary or detained patients are statutory. This is because such patients are subject to restrictions and compulsory orders, including compulsory treatment, which places them in a uniquely vulnerable position.

Rather than bringing voluntary patients into the scope of this clause, we feel it is more appropriate to use the Mental Health Act’s code of practice to embed high standards of care planning for all patients—voluntary and involuntary. Specifically with regard to children and young people, any provisions that are relevant to voluntary patients are already met by existing specialist care planning standards and the NHS England national service specification for children’s and young people’s services, which providers are contractually obliged to follow. NHS England is already in the process of strengthening that current service specification.

Regarding points raised by the noble Lord, Lord Kamall, and my noble friend Lord Davies on the contents of the care and treatment plan and patient discharge plan, as my noble friend Lord Davies kindly set out for me, which I appreciate, the Government have consulted on the required contents of the care and treatment plan, as originally proposed by the independent review. The expected contents of the plan are described in the delegated powers memorandum, which has been published online. I understand the points that my noble friend made; we will return to them regarding what we intend to include in the patient discharge plan.

I turn to Amendment 59, tabled by my noble friend Lord Davies and supported by the noble Baronesses, Lady Tyler and Lady Neuberger. The plan needs to include details of interventions aimed at minimising financial harm to the patient where this is relevant to their mental health recovery. My noble friend asked for my agreement on this point. I hope that he will take that in this way. We intend to set out in regulations, rather than in primary legislation, what that plan must include. We will consider personal financial matters that are relevant to a number of the elements that we intend to require in regulations, such as the services that a patient might need post discharge. My noble friend’s point, and that of the noble Baronesses, is very well made and is taken on board.

Turning to Amendment 60A, tabled by the noble Baroness, Lady Barker, I confirm that the Bill sets out who is responsible for the statutory plan. For in-patients, this is the clinician who is responsible overall for the patient’s case. The quality of plans for detained patients is monitored by the CQC. Any housing, accommodation or wider social care needs that are relevant to the patient’s mental health recovery are already captured within the scope of the statutory care and treatment plan. We intend to require in regulations about the content of the plan that a discharge plan is a required element of the overall care and treatment plan—which noble Lords rightly have pressed the need for. Existing statutory guidance on discharge sets out that a discharge plan should cover how a patient’s housing needs will be met when they return to the community. Currently, where a mental health in-patient may benefit from support with housing issues, NHS England guidance sets out that this should be offered, making links with relevant local services as part of early and effective discharge planning.

Where a person is receiving housing benefit or their housing is paid for via universal credit, there are provisions already in place that allow them to be temporarily absent from their property for a limited duration. We know that the vast majority of people entering hospital will return home before the time limit expires, therefore avoiding a negative impact on their living situation.

We intend to use the code of practice to clearly set out expectations on mental health staff around care planning, including consideration of accommodation and housing needs, and also to highlight existing provisions that protect a person’s living arrangements while they are in hospital.

On Amendment 61, tabled by the noble and learned Baroness, Lady Butler-Sloss, we of course recognise the importance of involving parents, guardians and those with parental responsibility in decisions around care and treatment. We have already provided for this in the clause by stating

“any … person who cares for the relevant patient or is interested in the relevant patient’s welfare”.

The clause seeks to include also carers and other family. As I said last week, this is consistent with existing established terminology used in the Mental Capacity Act and the Care Act.

The amendment would also make this a requirement for all patients, not just children and young people. We do not think it is appropriate here to give an automatic right to parents to be involved in an adult patient’s care. However, we have made provisions to ensure that anyone named by an adult patient, including parents, are consulted where the patient wishes them to be.

Baroness Browning Portrait Baroness Browning (Con)
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On that last point about adults, I realise this is a more difficult area, but we have debated in this House reports from the charity Mind about adults, and young adults at that, who, when they have been admitted not just to mental health hospitals but to general hospitals and have had difficulty communicating —I go back to autism, but it might not be uniquely autism—hospital staff have said, “They are over 18, so we’re not listening to you, mum”, while standing by the bedside asking why a person is not eating, when there is probably a very good reason why not. We have recorded deaths of young adults because the parents of people over 18 have not been listened to. It is a mantra that I have heard many times, in many situations: “They’re over 18, it’s up to them”, when, in fact, quite clearly, their lives could be saved, or their health improved, if hospital staff had listened to mum or dad at the bedside. That is on the record and we have debated it in the past, so I wonder how the Minister thinks we can resolve it as far as mental health patients are concerned.

Baroness Merron Portrait Baroness Merron (Lab)
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The noble Baroness is right to raise that point. This is the difference between legislation and practice, and we have to bridge that gap. We are very alive to the point she makes, but the important point about this amendment is that we are trying to include all those whom the patient wants to be involved, not just restricting it to parents. I take the point she has made and will, of course, ensure that we attend to that. I would say that that is, as I say, more a case of how things are implemented.

On Amendment 62, in the name of the noble Baroness, Lady Tyler, and the noble Lord, Lord Scriven, it is important that the transition of a young person to adult services is planned and managed with the utmost care by the clinical team. This is reflected in existing care standards and guidelines, which set out what should be met, what relevant teams should meet and how to provide specific support where a young person’s care is being transferred to adult services. This should take place six months prior to the patient turning 18 years of age. On reviewing the patient’s statutory care and treatment plan when they reach adulthood, in Clause 20, subsection (5)(d) of new Section 130ZA already sets out that that plan must be reviewed following any change in circumstances or conditions. We think that turning 18 and transitioning from children and young people’s services to adult is a significant change and absolutely requires review of the plan. We will make this explicit in the code of practice.

Finally, I turn to Amendment 64. I thank my noble friend Lady Keeley for sharing the reality of how this manifests itself by sharing with us individual circumstances. I also thank the noble Lord, Lord Young, whose work on young carers is well known and respected. We support the intention to ensure that children are properly safeguarded. If a person is known to services, immediate safeguarding needs to form part of the planning by approved mental health professionals on behalf of the local authority and others involved in the Mental Health Act assessment before bringing a person into hospital. If a person is not known to known to services, the professionals should work with the relevant agencies to make sure the necessary steps are taken. The statutory guidance Working Together to Safeguard Children sets out how all practitioners working with children and families need to understand their role in this regard.

Baroness Keeley Portrait Baroness Keeley (Lab)
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I just want to reflect that the noble Lord, Lord Young, said in his speech that young carers services almost never receive any referrals from adult mental health services, despite the provision that already exists and has done for a number of years in codes of practice. This is a difficult thing—I tried to bring in legislation for that in the other place on a number of occasions. I just thought that was worth pointing out.

Baroness Merron Portrait Baroness Merron (Lab)
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I thank my noble friend for pointing that out. On the points raised about protections for young carers, the code highlights that children who are caring for parents with severe mental illness are entitled to request a young carer’s needs assessment under the Children Act. It goes on to cover the information that young carers should be offered to help navigate such a challenging time.

Returning to the guidance about which I was speaking, as has been identified, it already outlines the responsibility of multiagency safeguarding partners. Protecting children at risk of abuse and stopping vulnerable children falling through the cracks is very much at the heart of the Children’s Wellbeing and Schools Bill, which was introduced to Parliament last month.

Baroness Watkins of Tavistock Portrait Baroness Watkins of Tavistock (CB)
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I thank the Minister. I want to raise the issue that so many children and adolescents are placed for care out of their area, which makes the subsequent treatment plan hard to manage. Can the Minister at least look at whether the code of conduct needs strengthening on that issue? For example, it could include a recommendation that a local team visits the person in the hospital before they are discharged. Of course, I would like to see more beds closer to home, but we have to face the reality.

Baroness Merron Portrait Baroness Merron (Lab)
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I appreciate that point, and I certainly would be happy to have a look at that.

20:45
Lord Kamall Portrait Lord Kamall (Con)
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My Lords, I thank all noble Lords who took part in the debate on this group. In responding to the Minister, I will touch briefly on some of the other amendments, but particularly on Amendment 57 in my name and that of my noble friend Lord Howe. I thank my noble friend Lady Browning and the noble Baroness, Lady Tyler, for adding their names to it.

On Amendment 61, I agree very much with the noble and learned Baroness, Lady Butler-Sloss, on the importance of parents and guardians, not only in respect of this amendment but all throughout the Bill and in the subsequent amendments that she tabled. It is very important that we do not forget that point and that we keep coming back to it.

On Amendment 58, in the names of the noble Baronesses, Lady Watkins, and my noble friend Lady Berridge, we are very sympathetic to the idea of extending this to under-18s. We have to reflect and may come back to this on Report.

The noble Lord, Lord Davies, and I were fortunate enough to have a conversation about his Amendment 59 during the dinner break. It is on a fundamental issue and we need to raise awareness of the link between finance and mental health. One can lead to the other: you might start off with financial difficulties and then find yourself with mental health issues, or mental health issues make it far more difficult to manage your finances. Frankly, when there are banks that do not necessarily understand the individual circumstances or are moving toward semi-automated decision-making, this is a whole minefield that we ought to tackle as soon as possible and not wait 20 years for the next mental health Bill.

On Amendment 62, in the name of the noble Baroness, Lady Tyler, continuity of care is absolutely important, and not just for mental health; I have been in debates in this House where it is really important for allergies or diabetes. When children are treated for a condition by children’s services they then worry, when they transfer to adult services, about whether they will continue to receive the same level of care, particularly if the clinician is different when they move over. They may well have had a very good relationship with that clinician as a child, but then they feel that they have to explain everything all over again, even though there are patient records.

Amendment 64, in the names of the noble Baroness, Lady Keeley, and my noble friend Lord Young, seems eminently sensible. It almost seems obvious; I was surprised that it does not happen at the moment. I take on board what the noble Baroness, Lady Keeley, said about previous attempts to put it into legislation; it must be fiendishly difficult.

One of the points that the Minister made was that young carers are entitled to some of the things that the noble Baroness was asking for. How do they know they are entitled to them? It is all very well to be entitled to them, but how do they know? This is true for physical health as well, but given it was raised on this specific issue, I would be interested in the Minister’s response. If she is not able to give that response, thanks to technology, over the airwaves to the iPad then perhaps she could include it in her letter to noble Lords afterwards.

The noble Baroness, Lady Barker, made an important point about Amendment 60A and housing. Housing, like finance, is one of those things that could lead to mental health issues, or having mental health issues makes housing much more difficult. The lack of adequate accommodation could lead to readmission, when we think about discharge afterwards, suitable accommodation and suitable circumstances.

I should be positive. I am grateful to the Government for the care and treatment plans in the first place. I think they are very sensible, which is why many noble Lords want them extended to not just that cohort of patients. I understand that sometimes we have to roll things out and learn from experience, and perhaps that can feed into future rollout—I understand sometimes not going for the big bang, as it were. On Amendment 57, I will read Hansard carefully and reflect on what the Minister said. I particularly thank her for the reference to the link to see what is being considered for inclusion in the care and treatment plan. I beg leave to withdraw my amendment.

Amendment 57 withdrawn.
Amendments 58 to 62 not moved.
Amendment 63
Moved by
63: Clause 20, page 30, line 5, at end insert “and provide information in a culturally appropriate manner.”
Member’s explanatory statement
The appropriate practitioner must provide culturally appropriate information when preparing or reviewing a care and treatment plan.
Baroness Whitaker Portrait Baroness Whitaker (Lab)
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My Lords, I have apologised that I was not able to be at the Second Reading of this most welcome Bill. I declare interests as a former member of the Tavistock and Portman NHS Foundation Trust board and various positions in Gypsy, Traveller and Roma organisations as set out in the register. I read the Hansard record of the Second Reading debate and was particularly heartened by my noble friend the Minister’s acknowledgment of previous legislation’s lack of attention to racial disparities.

This deficiency is especially applicable to the situation of Gypsy, Traveller and Roma people, which Amendments 63, 101, 107, 113, 116 and 124 address, but I warmly support the other amendments in this group. The communities I speak of are usually airbrushed out of consideration of race discrimination. That is partly because their numbers have been small when national surveys have been made in the past, even though the proportion within their populations who suffer the multiple effects of discrimination is larger than in any other recognised minority-ethnic group, and perhaps partly because they are not distinguished by colour.

I am grateful to the Traveller Movement for detailed briefing and to the noble Lord, Lord Bourne of Aberystwyth, and the noble Baroness, Lady Bakewell of Hardington Mandeville, for their support. The amendments I speak to are all intended to probe how this Bill can avoid the same cruel mistake of omitting ways to deal with the mental health effects of discrimination against these communities. Basically, they stipulate that mental health practitioners must be trained and obliged to ensure that the care, treatment, advice and information they give are attuned to the culture of the people they are looking after. In healthcare generally, almost one-third of respondents to a Traveller Movement survey said that they experienced discrimination. These are the voices that the noble Baroness, Lady Bennett, referred to, and I thank her for adding her name to one of my amendments.

There is reason to believe that this discrimination experience applies significantly to mental ill-health because this is not a familiar concept to some in the more traditional communities. Most of the rare, targeted provision has come from the voluntary sector. ONS research, which has now begun to put right the gap in our knowledge, shows that mistrust and fear of discrimination have delayed them seeking help. We do, however, still need its data to be disaggregated with regard to Gypsies and Irish Travellers, which are very different communities. Incidentally, the NHS data dictionary is not collecting such data at all, so the full picture may be even worse.

Amendment 63 applies the principle of cultural attunement to care and treatment plans. Only then would new subsection (6), which requires consultation to establish the patient’s wishes and needs, be properly fulfilled. This will mean taking account of possible mistrust, literacy rates, digital exclusion and any language barriers, because although Romani Gypsies and Irish Travellers have been in the UK for centuries, there may also be new arrivals from the Roma communities of east and central Europe.

Let me quickly sketch in the context. At present, one survey found that 66% of domestic abuse service providers—professionals—did not know how to engage with Gypsy, Roma and Traveller people. There is in particular a fear on the part of those communities that their children may be taken into care if they seek support for acute mental health problems, and some cases of suicide have thereby resulted. In fact, suicide is, tragically, much more common in these communities than in other groups. The NHS’s own research, carried out by the University of Worcester, cites an estimate that suicide is seven times more likely. It makes recommendations mandating specific cultural training in all aspects of healthcare. Research by Friends, Families and Travellers has found that lack of support from mental health and other public services is specifically mentioned by those affected to be one of the causes, together with cultural stigma. Anxiety is three times more likely and depression over twice as likely. The Roma Support Group also picks out cultural stigma as one of the barriers to effective treatment for mental illness, as well as lack of knowledge on the part of practitioners about the background of Holocaust survival experienced by older members of the Roma community, and often transmitted over the generations. Where literacy is low, it has been found that there is little understanding of mental health and insufficient access to services; and 46% from these communities reported that they had no access to digital primary care services.

Amendments 101 and 107 apply the same principles of trained cultural access to the provision of an independent mental health advocate, as does Amendment 112 to giving information about the complaints procedure. Amendment 113 brings in the providers of information on complaints for community health patients, and Amendments 116 and 124 do the same for advance choice documents in England and in Wales.

Finally, the Women and Equalities Committee pointed out in 2019:

“Despite the fact that information and guidance has been available to frontline healthcare staff for some time, discriminatory practices are more widespread than they should be”.


Apart from the new, most welcome planning policy, very little has changed since then, no doubt because the committee’s other recommendation, that there should be a cross-departmental strategy to tackle the overlapping inequalities faced by these communities, which have resulted in the worst health outcomes for any minority-ethnic group, was never developed by the previous Government despite the initial steps taken by the noble Lord, Lord Bourne, when Minister for Communities. The Minister has cited the NHS role in a

“wider equality monitoring review programme”

in a Parliamentary Answer. Can she tell the House how this will cover access to mental health services? The present lack of engagement is why cultural understanding, created by specific training, must be in the Bill. These amendments would help the Bill realise its ambition of fully informing patients of the choices available to deal with serious mental ill-health, strengthening their voice and improving their involvement in their own care. I beg to move.

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Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD)
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My Lords, Amendments 65 and 133, in my name and that of my noble friend Lord Scriven, are both about tackling racial injustices in the operation of the Act. I am sympathetic to the amendments that we have just heard about from the noble Baroness, Lady Whitaker, who set them out eloquently. I also strongly support Amendment 138, in the name of the noble Lord, Lord Kamall.

As I have said in previous debates, a primary driver of the review of the Mental Health Act was the shocking racial injustices in the use of the Act, and we need to have that front and centre in our minds as we work our way through the Bill. Addressing racial inequalities is one of the key issues identified in the 2018 review, and there remain concerns that the Bill still does not go far enough to address that deeply entrenched inequity. As I set out on the first day of Committee when introducing my amendment on including equity as an additional principle in the Bill, black people are more than three and a half times more likely to be detained under the Mental Health Act than white people and over seven times more likely to be placed on a community treatment order. I make no apology for repeating those figures because I think they are scandalous.

Evidence shows that, on average, people from racialised communities experience greater difficulty accessing mental health services and have poorer experiences and outcomes, and we have heard examples of that. For example, black or black British people are more likely to be detained for longer and to experience repeated admission. They are also more likely to be subject to police powers under the Act and experience higher levels of restraint. It is worth noting that the noble Lord, Lord Darzi, in his recent report on the NHS, said the use of restrictive interventions in in-patient mental health settings had continued to rise, and the most recent data shows that people from a black or black British background are still significantly more likely to be subject to restrictive intervention.

I readily acknowledge that there are some measures in the Bill that should have a positive impact for people from racialised communities—for example, the introduction of the advance choice documents that we were talking about earlier, which I very much welcome—but, in my view, the Bill in its current form still only scratches the surface, really. It does not take on many of the recommendations in this area from both the independent review of the Act and the pre-legislative scrutiny committee. Can the Minister explain why those recommendations were not taken on board?

I turn to my amendments. Amendment 65—and I thank the noble Baroness, Lady Bennett, for adding her name—is a probing amendment designed to understand better the Government’s thinking on how they intend to address racial disparities in the use of community treatment orders, which we debated at length on Monday. I do not want to repeat that, save to say that community treatment orders have been used more widely than anticipated and disproportionately on individuals from particular ethnic backgrounds. It is vital that this is closely monitored to ensure that the disproportionality in use is tackled head on. We must not focus just on reductions in the overall numbers of CTOs. Does the Minister agree that that should include collecting evidence on the effectiveness of NHS England’s patient and carer race equality framework and its approach to reducing the overrepresentation of people from black and minority ethnic communities?

Just to show that, rather like my noble friend Lord Scriven, I do not get out enough, I noticed that page 88 of the lengthy impact assessment talks about 13 pilots—trusts that have already started to make changes as a result of this anti-racism framework. Can the Minister update the House on their progress? If she cannot do so now, perhaps she could write to me.

We know that people from these racial backgrounds may also be reluctant to seek help from formal services, based either on previous negative experiences or in some cases because of social stigma attached to mental health issues within their own community. Amendment 133 would require mental health units to appoint a responsible person to address and report on racial disparities and other inequalities relating to the use of the Act. This is really important and it is vital that a new responsible person role is introduced at hospital level to oversee race equality and address inequalities in the operation of the Act.

The responsible person would be responsible for publishing a policy on how that unit plans to reduce racial and other disparities which are based on protected characteristics in that unit or community mental health service. They would have responsibility for monitoring data on equalities as well as overseeing workforce training and policies and drawing up policies to address bias and discrimination. In my view, the creation of a responsible person role at local level would materially help us to move forward to a more transparent and accountable mental health system, and this accountability would be reinforced and amplified by the responsibility this amendment also places on the Secretary of State to report on progress made on reducing inequalities at national level. That is set out in proposed new Section 120H.

I really believe that such a dual-pronged approach to clear and transparent accountability could make a tangible difference in this critical area of public policy, and I look forward to the Minister’s response.

Baroness Bennett of Manor Castle Portrait Baroness Bennett of Manor Castle (GP)
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My Lords, as has already been acknowledged, I have put my name to Amendment 63, tabled by the noble Baroness, Lady Whitaker, and Amendment 65, tabled by the noble Baroness, Lady Tyler. Both of them have done a comprehensive job of introducing the amendments so I will be extremely brief.

The noble Baroness, Lady Whitaker, is well known in your Lordships’ House for championing the many issues affecting Gypsy, Roma and Traveller people. I particularly wanted to sign Amendment 63 because it is a very broad-ranging amendment—it is crucial that everybody gets culturally appropriate forms of explanation. It struck me as we were debating that we are focused now on mental health, but I think this probably would also apply right across the NHS to physical health because there are, of course, cultural differences in understanding our bodies, et cetera.

If we imagine the case, perhaps, of a refugee who suffers mental health difficulties, having fled their home country, where they were subject to abuse by the authorities. It is important to make sure, if they are to be sectioned, that that is carefully explained to and understood by both the patient and potentially the patient’s family. There needs to be an extra level and a sensitivity to that person’s circumstances. We will all have different circumstances, but it is important to look at it in that broad frame.

On Amendment 65, we have already canvassed quite extensively the way in which minoritised communities are currently seeing significant disparities in the way they are treated under the law in the area of mental health, particularly in community treatment orders. The noble Baroness, Lady Tyler, described this as a probing amendment. Whether this is the exact means or not, it is clear that we have to have much better data and to make sure that as soon as trends and patterns emerge in that data, they are acted on. It is encouraging to hear that this is being piloted and work is being done but it is crucial that this becomes standard and that is why it is tempting to feel that it really has to be in the Bill.

Lord Bishop of Manchester Portrait The Lord Bishop of Manchester
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My Lords, I support all the amendments in this group. I also want to communicate the support of my right reverend friend the Bishop of London, who apologises that she cannot be in her place this evening.

Turning to the amendments led by the noble Baroness, Lady Whitaker, on culturally appropriate care, I appreciated the noble Baroness’s references to the Gypsy, Roma and Traveller community. I have worked with that community much over many years and very much enjoyed my interactions with it.

These amendments highlight issues that my right reverend friend has spent a lot of time considering, particularly from a faith perspective. I do not think we have heard that in the debate so far tonight. It is sometimes hard to grasp just how differently our health, especially our mental health, is culturally understood across different communities and faith groups. While our ability to discuss our own and others’ mental health may be generally improving—I think it is—it remains an extremely difficult discussion point for many cultures and many communities.

When you combine that with the extensive inequalities of outcomes that we find, and many people’s experiences of culturally inappropriate care in mental health and other settings, it is inevitable that many people are reluctant to engage with preventative services. It was said at Second Reading that minoritised communities are likely to engage at a crisis point rather than seek early interventions. My wife worked for many years as a maths specialist in the home and hospital tuition service of a large urban authority. She regularly found that she was working with pupils whose mental health needs had been picked up late, if at all, because the culture of the parental home saw mental health issues as shameful, and not something you could raise with external service providers. So culturally appropriate care is a crucial step if we are to build the trust that is ultimately vital to reducing health inequalities.

In order that culturally appropriate care is deliverable, training on faith literacy, as well as different cultures and beliefs, will be crucial. Again, I have found that myself; I have been working with my fellow faith leaders in Greater Manchester, including the excellent Caribbean and African Health Network. I make no apology for banging on about religious literacy in your Lordships’ House on yet another occasion: it does really matter. Service providers in all sectors do us a huge disservice when, through their own faith illiteracy, they operate with a presumption that religion matters only in the realm of private affairs. Getting it right in this Bill will of course necessitate additional resource. In supporting these amendments, I hope that sufficient resources will be allocated to this work.

I turn finally to Amendments 65, 133 and 138, in the names of the noble Baroness, Lady Tyler, and the noble Lord, Lord Kamall. I am a statistician by background. We know the importance of good and useable data to ensure that we have an understanding not just of the gulfs of inequality of outcomes but of the more nuanced and complex patterns that lie underneath them. Amendment 133 recognises the need for regular training and has a consultation element as part of the policy. I hope this will be taken up and I hope that will include consultation with faith groups. We must commit to work with such groups to build trust with communities that service providers are wont to call hard to reach. I do not believe we should call any group in our society hard to reach. What we do have, all too often, are service providers who just do not make enough effort to reach. So instead, let us work with organisations such as CAHN, which I mentioned earlier, to ensure earlier interventions than those we often see.

I also warmly welcome Amendment 138, which, as others have said, highlights an appalling scandal in our society. I thank the noble Lord, Lord Kamall, for tabling that amendment.

Lord Davies of Brixton Portrait Lord Davies of Brixton (Lab)
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I know the hour is late, but I want to note the irony that the issues covered by these amendments are central to the whole process of why we have arrived at this Bill. In a sense it is unfortunate that, because of the hour, there are so few of us present. I want to stress that we cannot assume it is job done. It is really important to keep this whole area under review, whether we do it precisely in the terms of the amendments before us or not. I urge my noble friend the Minister to give an assurance that this issue will not be left for another 17 years before we decide that we have got it right, and that the workings of the Bill in this central area will be kept under close and continued review.

Baroness Berridge Portrait Baroness Berridge (Con)
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My Lords, I will speak briefly in support Amendment 133. I know the hour is late. As I asked the Minister, why is it that issues relating to this focus, which was the focus of the Bill, seem always to end up at the end of our debates? I am not sure why, but they are some of the most important issues. I reflected at Second Reading and earlier in Committee on the Joint Committee’s work and our concern about the strength of civil society and media focus on this issue. Although what we saw seemed expert, we then saw a comparison with what I would call Premier League—which was learning disabilities and autism in terms of that focus.

I turn to new Section 120H, which the noble Baroness, Lady Tyler, mentioned, and the statistics I cited before. The right reverend Prelate mentioned the importance of data. It is very concerning that, when we talk about the data on under-18s, we are not quite clear about what is going on in relation to it. The data on under-18s that I mentioned has three subgroups: those who are detained, those who are in the cohort because their parents have consented and those who have consented themselves. It is imperative that we know exactly which subgroup is which in the under-18s group—which, thankfully, is a small group of about 1,000.

Even in the data I cited from the UCL study, of the 23.6% of under-18s that were detained, three times as many black young people were detained as their counterparts. That issue is starting early. What is happening even at that early stage—the disproportionate number detained under the Act—was also reflected in the data on the lack of parents consenting to children going into hospital for the treatment that they need.

21:15
With new Section 120H and reporting, I hope that the Minister will focus on young people and outline that we will have very detailed data on that cohort going forward. It is with great sadness that we stand here, knowing that our mental health laws are not working. It has now been over six years since the review, but we have still not legislated and we seem to be not much nearer to understanding the causal factors.
Finally, I note as a postscript that it is not only the understanding that the right reverend Prelate outlined. When one looks at training—obviously, we always talk about the training of healthcare professionals, et cetera—we see that, because a disproportionate number of people from ethnic minority communities are still within some kind of faith community, it is imperative that there is a heightened awareness of the need to train leaders, in those worshipping centres and other support groups, to recognise that many people repeatedly present as needing prayer in a Christian context. But they do not need prayer; they need to be told to go to their GP. For that reason, they often present later and they are often sicker by the time they present. Based on research I read a while ago, that is one of the reasons why in the black community there is later presentation; they are not accessing the services earlier. So can the Minister include in the focus of training that it is not just clinicians and those to whom the code of practice applies that need it?
Lord Kamall Portrait Lord Kamall (Con)
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My Lords, during the debates on this Bill—and throughout my time in this place—I have learned that there are specific topics about which other noble Lords are passionate. For example, the noble Baroness, Lady Hollins, who is not in her place for sad reasons, is passionate about many issues; but, in the context of this Bill, she has long championed issues around the detention of those with autism and learning disabilities, as has my noble friend Lady Browning. My noble friend Lady Berridge is very passionate about children and young people and about tackling racial discrimination, and the noble Lord, Lord Davies, is very passionate about the link between finance and mental health. Many noble Lords are passionate about specific issues. For me, Amendment 138, in my name and that of my noble friend Lord Howe, goes to the heart of an issue in which I very strongly believe, based on my own experiences of racism while growing up in Britain.

Before I go into that, I will touch on the amendments from by the noble Baroness, Lady Whitaker. In one of my first work experiences—in Chase Farm Hospital many years ago—I got to know and speak to a young patient from the Traveller community. He told me about the problems that the Traveller community had in getting access to medical care, and how members of the community were always treated with suspicion and not in the same way. So I am very sympathetic to those amendments.

To get back to my own experience, the Britain of recent years, which my children grew up in, is much less racist than the Britain that I grew up in the 1970s and 1980s, when it was common to be called offensive names or to be chased by skinheads, sometimes actually with weapons and knives. But my experience was a lot better than the racism that my father faced when he came here in the 1950s. There are horrendous stories that he told my siblings and me when I was younger. I believe that we can be proud of that progress, as a country and a society.

When I was a Member of the European Parliament, I used to chat to the taxi drivers in Belgium and France. I would tell them that I was from London, and not all of them but many of them would say how lucky I was, since they had a friend or relative in London and they thought that London was incredibly diverse and tolerant compared with where they lived. That was very touching to hear—but I have to admit that that is my experience, and some will have had different experiences. Even my experience does not mean that the battle against racism and racial disparities is over. As many noble Lords, including the noble Lord, Lord Davies, the right reverend Prelate and my noble friend Lady Berridge, have rightly said, we have to be vigilant on this.

As the noble Baroness, Lady Tyler, said, one reason for the review and this Bill is because my noble friend Lady May commissioned the Wessely review due to the disproportionate number of black people being issued with community treatment orders or being detained; noble Lords have referred to this. We have known about that issue for a long time. Although politicians in the other place and many noble Lords here have raised the issue many times over many years, we do not really seem to have grasped the issue or to be on top of it. When I ask colleagues and medical experts about the disparity, I get a variety of answers. In the absence of any widely distributed and comprehensive study, the vacuum is filled by anecdotes or assumptions, sometimes racial stereotypes. One of the most common responses I have heard is that it is complex or multifaceted.

I remember when I did not initially get into the local grammar school, despite having the best grades in the class—better than some of the white pupils who got into the school; it also happened the previous year, in the year above me, when one of my friends who was black, an Afro-Caribbean, topped his class and did not get into the local grammar school—and my mother challenged the decision and asked for the reason, she was told “It’s complicated”. Fortunately, she persisted, and I got my place thanks to the help of my local Member of Parliament, who later became the late Lord Graham of Edmonton, may he rest in peace.

So when I hear the response, “It’s complicated”, I hope noble Lords will understand that I am simply not satisfied with that answer. It is just not good enough any more. The purpose of my amendment is to probe the Government to understand what they know and what research they are aware of, so we can understand the reasons for these racial disparities and put in place measures to tackle them. If it is complicated, can the Government or NHS list the various reasons and say what they are going to do about it? As noble Lord after noble Lord has said, we need the data.

The noble Baroness, Lady Barker, who is not in her place, reminded noble Lords that many of the answers from the Minister sound similar to the responses from 20 years ago. That is not a political point. I suspect that the answers given by the Minister, who is well liked and respected, would not be very different from the answers prepared by officials for any Health Minister of any party. Some of the answers are probably very similar to answers that I gave when I was a Minister. That is not to disrespect the diligent civil servants in the department, who work really hard, but we need answers to the following questions.

What studies are the Government, DHSC and NHS aware of? What do we understand from the various studies? What secondary data do we have, and what are the known unknowns? What do we know that we need to know more about? Has there been any attempt from that secondary data to generate the questions for the primary research so that, once and for all, we can understand why a disproportionate number of black people are subject to community treatment orders and to being detained? Do the Government, DHSC or the NHS, if they have the data, know how to use it to reduce those disparities? If so, when will they begin to reduce these disparities?

I was very pleased to hear a reference to some of the pilot schemes. Perhaps the Minister can refer to some of those schemes, and maybe that would be helpful. But I have to say that if the answers that we receive to these questions, either tonight or when the Minster writes to noble Lords between now and Report, are not adequate, I suspect that noble Lords will have to send the Minister back to the department to kick the tyres and get a better answer. It is as simple as that; otherwise, I am afraid that we will return to this issue on Report. If it comes to that, I hope that we will not see a Government urging noble Lords from the governing party to vote against an amendment that would seek to tackle these huge racial disparities in a methodical way and with an evidence-led approach. I look forward to the Minister’s response.

Baroness Merron Portrait Baroness Merron (Lab)
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I thank noble Lords for the points they have made. I shall start with those from my noble friend Lady Whitaker regarding Amendments 63, 101, 107, 113, 116 and 124 and immediately address the point about the limited available data on Roma communities.

I absolutely acknowledge that the data on Gypsy, Roma and Traveller communities is indeed very limited. I emphasise that I say this not as an excuse; it is just what I have discovered. This is largely due to lower numbers, but we are working with NHSE to improve ethnicity reporting for all patients. More broadly, the Office for National Statistics is working with a range of government departments to undertake research into the barriers and enablers for this community in accessing a range of public services, including mental health services. Findings are expected later this year. I know my noble friend has been very active in pursuing this point and I am grateful to her for doing that. I hope that will be a generally helpful response.

I add to all noble Lords that I absolutely agree that information, communication and support should be provided in a culturally appropriate manner. However, we do not believe that the amendments would achieve that aim, nor are they necessary. The duty to take cultural differences into account in how services are delivered is already enshrined in the Equality Act 2010. These existing duties are the legal basis for ensuring that services are culturally appropriate. That said, we absolutely acknowledge that, in practice, many services still fall short, but that is the position that we find ourselves having to tackle. This is where we need to strengthen guidance. The patient and carer race equality framework is already in place to strengthen the application of these principles, and we will strengthen guidance in the code to ensure that duties under the Equality Act are embedded in practice. We therefore believe that these amendments would not have any additional benefit above what is already in place and what is planned.

On Amendment 65, tabled by the noble Baroness, Lady Tyler, we recognise that there are very significant disparities in the use of community treatment orders between different groups. This data is published as part of the annual Mental Health Act statistics. As the noble Baroness said, in 2023-24 it certainly was the case that patients from black and black British ethnic groups were around seven times more likely to be placed under a CTO than those from white groups. I add that patients from all minority ethnic groups are more likely to be subject to the use of a community treatment order than patients who are white. These disparities are explored in the impact assessment.

The noble Lord, Lord Kamall, drew on his personal experience, for which I thank him. I am sorry that he has to bring that personal experience here, but of course it is the case that the battle against racism and racial disparities is far from over—I completely agree. I am sure he will have noted the commitments made by this Government to tackle racism and racial inequalities, particularly in the NHS and social care.

The reality is—many noble Lords have spoken about this—that we are in a position where we have less data on outcomes and patient experience of being subject to community treatment orders. Officials are now working with NHS England and system partners to understand what additional data it would be wise and helpful to collect. We will cover CTOs in the planned independent evaluation of the reforms but, as ever, I have to share, in honesty, that it will take time to gather new data. A review after 12 months would be premature, not least because it would mean it was based on data from before any reforms commenced. I do not feel that that would be helpful. I assure noble Lords that, rather than committing in legislation to a review at a fixed date, we are committed to keeping existing and additional future data under review.

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Lord Scriven Portrait Lord Scriven (LD)
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I think one of the reasons why people are asking for an open and transparent review—and, in some cases, one that reports back to Parliament—is that this is about not only the data but accountability for carrying out actions and implementation. That is the bit that is missing. Everything I have heard from the Minister on this subject so far—maybe she is coming on to say something else—suggests that without accountability, and overview and transparency of that accountability, the guidance is not going to work. Believe me, as somebody who used to work in the service: if you know that the Government were looking at this and that it was going to Parliament, it sends a powerful message for action to be taken in each individual unit. That is what is required, and I do not see that coming from the Minister’s answers. Can she tell me where that accountability streak will be, and how we, in this House and the other House, can put pressure on if the guidance is not being followed, based on the process she has outlined?

Baroness Merron Portrait Baroness Merron (Lab)
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I understand the point the noble Lord makes. However, it does not lead me to accept the amendments. I understand the intent and I am sure noble Lords realise how sympathetic I am to it, but I repeat the point I made earlier: if one looks at what the amendment actually does, it will not serve that purpose. I take the point about transparency and accountability, and I hope the noble Lord has heard many times that that is very much the mode of direction. Perhaps it will be of some assistance to say that the PCREF will improve data collection on racial disparities over the coming year, and the CQC has existing duties to monitor and report on inequalities under the Act. We will continue to monitor racial disparities in the use of CTOs. That situation will be ongoing. If it is not doing the job that it is meant to do, we will not be complacent and will seek to act.

We agree there is a need to improve organisational leadership—

Baroness Berridge Portrait Baroness Berridge (Con)
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Just before the Minister talks about that point, I understand her concern about the 12-month time limit, because it would be before the reforms are introduced. However, is she satisfied that there will be a robust baseline before the reforms are introduced so that we know what we are measuring against? Otherwise, in a few years’ time, we could be asking whether the reforms have worked, but we would not know because we did not have the baseline data. That is the starting point.

Baroness Merron Portrait Baroness Merron (Lab)
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The noble Baroness is quite right: one has to be able to compare, and that baseline will be in place. You could collect all the data you like, but it has to be meaningful. Her point is well made.

There is a need to improve organisational leadership to improve data collection and change culture across the mental health system. Again, this is exactly what the PCREF is designed to do and something we want to embed further through the revised code of practice.

The creation of a responsible person was an additional recommendation from the pre-legislative scrutiny committee, and it is one we have considered in some detail. However, ultimately, we think that the role is not necessary, because it would duplicate existing roles and duties. There are already duties on providers of mental health services to identify and address inequalities relating to protected characteristics under the Equality Act 2010 and specifically the public sector equality duty. CQC already has a duty under the Mental Health Act to monitor as health services exercise their powers and discharge their duties when patients are detained in hospital or are subject to CTOs or guardianship. It publishes an annual report, Monitoring the Mental Health Act, which includes detailed commentary on inequalities. The PCREF is now part of the NHS standard contract. It has created new contractual obligations on providers to ensure that they have a framework in place to record and address racial inequality in mental health systems and to look at training and other policies to address racial disparities. Ultimately, we do not think that a responsible person is necessary to achieve all the aims, which are understood, set out in the amendment.

Finally, I want to turn to Amendment 138 tabled by the noble Lord, Lord Kamall, and supported by the noble Earl, Lord Howe. We recognise, as I have said, that there are significant inequalities in the use of detention under the Mental Health Act and of CTOs between different minority-ethnic groups, and in particular the overrepresentation of black men. We monitor those inequalities through routinely published data and are improving this data through the PCREF. The CQC, as I have mentioned, reports on inequalities in its annual report under existing duties, but we agree that we lack robust evidence on what drives those inequalities, and that has been a matter of considerable debate in your Lordships’ House. We need to conduct research into this, and we are exploring with experts, including academic researchers, the best way to tackle it.

I am concerned that two years is not enough time to scope and commission the report, collect and analyse new data, and form meaningful recommendations. Additionally, we hope that through improved decision-making under the reforms we will see a reduction in the number and proportion of black men who are subject to the Act and a reduction in racial disparities more generally. It is a major driver of why we introduced the Mental Health Bill. A report after two years feels premature, because it would be likely to be based in reality on data from before the reforms were commenced.

Lord Scriven Portrait Lord Scriven (LD)
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I am grateful to the noble Baroness for giving way and sorry for interrupting her flow again. The point about having a staging report after two years is to get ahead and upstream of what is happening rather than retrospectively being able to do stuff after it has gone on. Two years in management terms to be able to determine trends of intended or unintended consequences and then put different things in place is really important. I believe that this amendment, with a report back to Parliament, would send a very strong signal and allow the Government, the department and NHS England to pick up trends, even if it was not the total picture, which would determine different policies and practices and potential changes in the code as well as management action. I think that is what lies behind the noble Lord’s amendment.

Lord Kamall Portrait Lord Kamall (Con)
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I am sorry to interrupt at this time. I note that the noble Baroness thinks that 12 months is too short, and many noble Lords can perhaps see the point that two years is too short. Does the department have any idea of what a reasonable timeframe is? There has to be some accountability, as the noble Lord, Lord Scriven, said. We could accept the warm words and the intentions of the Minister here tonight, but what happens if nothing changes? Where is the accountability? Can the Minister think about asking the department whether there is a reasonable timeframe for some meaningful research? I have supervised academic theses over time. You can have the one-year and then you go on to the three-year for PhD, and sometimes that is quite comprehensive data. There might be a meta study that could be done of lots of existing studies. First, what is a reasonable time? The noble Baroness does not have to answer now; it can be in writing. Secondly, if we let this go, how do we make sure there is accountability? How do we come back to this in three years or four years or five years? I look forward to the answer.

Baroness Merron Portrait Baroness Merron (Lab)
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I was about to say that I do understand the need for pace, but I know that noble Lords understand the need to get this right and I know they are not suggesting that we should get it wrong. I will certainly be glad to look at the points that have been raised. I assure noble Lords that I do not want this to be warm words and I understand what noble Lords are seeking. I want to ensure that it is right and that the pace is right. I will look at the points raised because—although I do not think anyone is accusing me of this—it is the exact opposite of avoiding accountability and transparency; it is just about dealing about what is in the amendments.

The noble Lord, Lord Kamall, asked me a number of very pertinent questions and to do justice to them I will write to him. In conclusion, I hope that noble Lords—

Lord Bishop of Manchester Portrait The Lord Bishop of Manchester
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Before the noble Baroness sits down, could I tease out from her a few words about the religious literacy point that myself and the noble Baroness, Lady Berridge, raised earlier? While we have rightly focused much on race and ethnicity this evening, which is important, I find that sometimes people take a pride in being religiously illiterate and in not paying attention to somebody’s faith in a way that they would probably not take a pride, as a professional, in not attending to somebody’s ethnic background. Does the Minister have a little word to say about that?

Baroness Merron Portrait Baroness Merron (Lab)
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I suspect that the right reverend Prelate knows where I would be coming from on this. He and the noble Baroness, Lady Berridge, are quite right that consideration of one’s religion and religious practices and not making assumptions about them are absolutely crucial.

Baroness Whitaker Portrait Baroness Whitaker (Lab)
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I thank my noble friend for her understanding of the crucial meaning of the data shortage and for her very helpful account of further work. The problem with relying on Gypsy, Roma and Traveller being covered by equality legislation guidance is that, unless they are specifically named as what they are, lots of people have no idea that they are there, that they are subject to an appalling level of discrimination and that they need a targeted response, directed—as it would be with a faith community or other community—at the reason they are so discriminated against.

But, on the whole, I am glad that the Minister has got the point about so many things and I sense that she has sensed the depth of feeling raised in this very short debate. I will thank very briefly everyone who joined in. The noble Baroness, Lady Bennett of Manor Castle, quite rightly pointed to the range of cultures that are potentially alienated by not being understood at all, as well as the need for data. I was very grateful for the support of the right reverend Prelate the Bishop of Manchester, because what he says is based on his real experience. I am very glad that my noble friend Lord Davies went on about the centrality of this issue; it is not a marginal add-on, it is part of our society. Of course, the plea of the noble Lord, Lord Kamall, for more research and proper data is really essential. I enjoyed his note of hope and I hope very much that we will be able to continue it and increase the progress. I had better withdraw my amendment for the time being, but we may need to return to this.

Amendment 63 withdrawn.
Amendment 64 not moved.
Clause 20, as amended, agreed.
Clauses 21 and 22 agreed.
Amendments 65 to 67 not moved.
Clause 23 agreed.
House resumed.
House adjourned at 9.45 pm.