Mental Health Bill [HL]

Committee stage
Monday 24th February 2025 Lords Chamber

Committee (5th Day) (Continued)

21:08

Amendments 150 to 160 not moved.

Amendment 160A

Moved by

[Baroness Fox of Buckley]

160A: After Clause 50, insert the following new Clause—
“Review: impact of this Act on the prison estate(1) Within 12 months of the day on which this Act is passed, the Secretary of State must publish a review of the impact of provisions in this Act related to the treatment and care of mentally disordered persons on—(a) under 18s in youth offender institutions,(b) IPP prisoners,(c) female prisoners, and(d) any other such persons they deem appropriate.(2) In the review, the Secretary of State must assess whether, in their view, the Act provides adequate support for ongoing treatment and care of mentally disordered persons in a prison setting.”Member’s explanatory statement
This amendment requires the Secretary of State to publish a review of the impact of the provisions of the Act on prisons and to assess whether the Act provides for adequate support for ongoing treatment and care in these settings.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, after all that excitement, I fear I may be a bit of an anticlimax, but I will carry on regardless—and let people walk out. My Amendment 160A calls for a review of the impact of the Act on the prison estate and the ongoing treatment and care of mentally disordered people in a prison setting a year after the Act passes. We have all welcomed the Bill’s commitment to ending the use of prison cells as so-called places of safety, but as some of us noted in the debate on an earlier group, the promise of, for example, a transfer to hospital for prisoners facing acute crises within 28 days is widely viewed by criminal justice stakeholders as unlikely to happen. We need to review whether such cynicism is merited, because the prison reform aspects of the Bill are not minor. They should not be treated as Cinderella clauses: they are, to my mind, crucial.

We cannot pass this Act and leave prisoners who ought to be in hospital beds abandoned in squalid conditions in jails. Additionally, it is not fair to prison staff because, to quote Andrew Neilson from the Howard League:

“Our overcrowded prison system that has been asked to do much, with too little, for too long, is ill-equipped to help people who require intensive support for their mental health”.


I recently visited Five Wells prison in Wellingborough with my Academy of Ideas hat on. The new leadership team at Five Wells is doing some fantastic work on purposeful rehabilitation activities, and we hope to do a joint project of Debating Matters Beyond Bars with it there. I chatted more generally to the team members, who have worked in a variety of prisons over the years, and they all noted that the time and emotional strain on staff when dealing with psychotic and very poorly prisoners—they gave gory examples of prisoners eating their own faeces or making very bloody attempts at self-harm, et cetera—have been totally demoralising for officers. It may have been one of the reasons for the use of the segregation units I talked about earlier. But these things have also had a destabilising and frightening impact on other prisoners. Sharing space with those with paranoid delusions and who present a violent threat to themselves and others is no joke; it makes prison difficult for everyone. So it is crucial that we get this right in the context of an overstretched prison crisis, and a specific view would focus minds.

I also think that we cannot let the Bill pass into law without acknowledging that there is considerable public disquiet about the relationship between criminal justice and mental health care. What do we do about the detention of those convicted of serious crimes due to diminished responsibility, where professionals see secure hospitals as more appropriate than prison? I am sure we can all recognise that, for many victims and their families, this hospital option can feel like an injustice.

I am, of course, thinking of the high-profile and controversial case of Valdo Calocane. According to the recently published independent investigation, it was repeated failures to treat Calocane’s paranoid schizophrenia and violent outbursts that left him free to kill Barnaby Webber, Grace O’Malley-Kumar and Ian Coates in June 2023. More pertinently in relation to the Bill, the families of these tragic victims fear that Calocane may have been spared prison due to incomplete evidence presented in court, especially about his mental capacity. This is now exposed in the 302-page investigative report, and the families have concluded:

“This was a man who actively avoided his medication and treatment, knowing that when he didn't take his medication he would become paranoid and violent”.


This is interesting for our deliberations, because we now know that the doctors responsible for Calocane’s case repeatedly ignored the nurses treating him in the community, who begged for him to be put on a CTO to ensure that he took long-acting anti-psychotic drugs. Why were they ignored? It seems that the clinical team at Nottinghamshire Healthcare Foundation Trust made decisions “influenced” by the draft Mental Health Bill 2022. Those medics were very conscious of legislation down the line that seeks to raise the threshold of detention and reduce the use of CTOs, and of the call for a reduction of compulsion in medicating patients in the community. Then there is the issue of patient rights, in Calocane’s reluctance to take medication because he did not like needles. Staff were, we are told, acutely aware of the Bill highlighting the “disproportionate” use of restrictive practices on black African or black Caribbean patients—and so on and so forth.

21:15

So, surely—this is the reason I raise this—we need to ensure that this Bill does not lead to such misinterpretations, with tragic unintended consequences. When I asked the Minister how the findings of the Calocane investigation would impact on this law, her answer seemed unclear in terms of timings, but if “lessons will be learned” is to be more than a placating evasion, perhaps this amendment or something more precisely worded would give the Government a chance to review the impact of the Act on criminal justice and mental health in general. The whole dispute about prison versus hospital for the most serious cases could then, in fact, be dealt with.

We will also need to review exactly how the Act will interact with the actual prison estate, not an imaginary one. Regardless of the 28-day rule, seriously mentally ill people will still be incarcerated in prison. One complication is that some prisoners are likely to deteriorate in jail, so much so that they arrive at an acute crisis phase. In some instances, this is because of the inadequacy of mental health service provision in prison.

One evidential marker of this relates to recent revelations that four out of 10 prisoners who have taken their own lives in custody in recent years did so because they were denied adequate healthcare before their death. Here I give huge credit to the journalism of Amy-Clare Martin of the Independent. Amy has recently exposed the scale of neglect, showing that 104 out of 233 self-inflicted deaths investigated by the prisons watchdog between 2020 and 2023 show failings in mental health care in jails.

I will focus on just a couple of cases to illustrate the point. The coroners’ court heard of one prisoner who took his own life at HMP Risley, 37 year-old Jason McQuoid, who did not eat or sleep for three days and begged for help after being put in one of those infamous segregation units that we discussed earlier. Jason’s family repeatedly warned that he was going to take his own life, but he still was not seen by any mental health clinician in the 72 hours before his death. No wonder they described his treatment as “medieval”.

Similarly, at another inquest in December, it was found that neglect and a failure to procure basic medical attention contributed to the death of Haydar Jefferies. Haydar took his own life in HMP Coldingley in February 2023. Shortly before his death, he was observed naked on all fours in his cell, barking like a dog, in the throes of severe depression and suffering acute psychosis, yet staff did not provide him with any medical attention. That is, of course, shocking, but perhaps more shocking is that Mr Jefferies’s mental health rapidly deteriorated after he was recalled to prison, having successfully rebuilt his life on the outside. The recall, based on an unproven and later withdrawn allegation, was under the terms of that discredited and abolished sentencing regime, IPP. What is more, the coroner noted that the postponed parole hearings—plural—

“more than minimally contributed to the development of psychosis, due to the psychological stress”.

Complaints about the inequities of IPP sentences are familiar in this House and to the Minister, yet the state still incarcerates 2,600 people indefinitely. Although, brilliantly, there has been reform of the draconian IPP recall regime, there is still a whole body of evidence to suggest that mental distress is one of the most pervasive and intrinsic factors associated with IPP sentences. That is not because of pre-existing mental health issues but is a distinctive characteristic of the specific sentence itself, over and above the general experience of imprisonment. The way the sentence is psychologically toxic is well documented in the literature, assessed invaluably in UNGRIPP’s report Making Sense of the Mental Health of People Serving an IPP Sentence by Donna Mooney and Sophie Ellis.

Pertinent to our discussions of this Bill, IPP prisoners are often very frightened to disclose their mental health problems or ask for help from prison staff, because poor mental health is regularly cited as a reason to knock back their parole. This can lead to untreated illnesses becoming more acute and in need of the provisions of this legislation. It also suggests that some of these IPP prisoners are, in effect, being detained by the state because of their mental health challenges, without that being acknowledged, and this could be seen as a sort of section by the back door.

These Catch-22 situations for IPP prisoners are illustrated by the harrowing plight of Thomas White, the father who has spent 13 years in prison for the street robbery of a phone, which I raised at Second Reading. Two medical reports last year laid bare the toll of his IPP jail term on the 42 year-old Mr White, warning that his lengthy incarceration had created “impermeable barriers” to his recovery. Recently, Thomas set himself alight in his cell in desperation, and, since then, the latest news from his family and his Member of Parliament is just awful. He is now totally disengaged and has lost hope. The cause is the denial of a hospital transfer, a very key part of this Bill. Thomas’s sister, Clara White, explained the dilemma. She said:

“If I took him to A&E and sat there for three hours he would be admitted to hospital”—

I thought three hours was a bit optimistic, myself—

“but prison staff said that he would have to display three months of stability in prison to be reassessed for a hospital transfer. So a man with paranoid schizophrenia has to pretend he’s not got it in order to get hospital care—that is ludicrous”.

That is the kind of problem that the review and special audit that I am suggesting in my amendment would allow us to look at: the particular impact on IPP prisoners as a specific group.

Finally, I will raise an issue that threatens to confuse our aim of reducing the use of prisons as a place of safety: the contested diagnosis of personality disorder. That is often used, in fact, to define and label people as dangerous or risky, while potentially masking mental health problems. It has been used in relation to IPP prisoners, whose failure to accept the inequities of their sentence can be pathologised as anti-sociability and disordered personality, but it is also a syndrome that is prevalent in the women’s estate and in young offender institutions.

My main query is whether those put on the offending personality disorder pathway—which, by the way, does not require a formal diagnosis by medical staff—does not muddle up those prisoners who might need more direct mental health treatment and instead just get the label of “behaviour disorder”. I hope at least, at the level of probing, that the Government can explain how we can ensure that the parts of this legislation relating to prisons are not provisions that might tick a box but get neglected, and that they will have a real impact. At least a review would help ensure that we keep our eye on prisons. I beg to move.

[Baroness Tyler of Enfield (LD)]

My Lords, I had not intended to come in on this group, but, having just heard the very powerful—and, in places, very alarming and harrowing—speech from the noble Baroness, Lady Fox, I will just ask the Minister whether he can explain what plans the Government have to assess and evaluate the impact of the provisions of the future Act on prisons and the criminal justice system, even if they are not planning a formal review. We need to know how the impact will be assessed.

[Lord Kamall (Con)]

My Lords, during the passage of this Bill, both the noble Baroness, Lady Fox, and the noble Lord, Lord Bradley, who is not in his place, have spoken passionately about people with mental health issues in prison. The noble Baroness, Lady Fox, referred to Valdo Calocane, and I know that the Government have instigated an inquiry. That particular case was the motivation for Amendments 160BA and 160BB in a later group, to which my noble friend Lord Howe will speak.

During the earlier debates on this, both at Second Reading and in Committee, I was particularly struck by the remarks of the noble Baroness, Lady Fox, on Chief Inspector Charlie Taylor’s graphic description of seriously mentally ill people in prisons being akin to a Victorian nightmare. After that debate, I read some of what Charlie Taylor had said, particularly about his visit in 2022 to Eastwood Park, where he witnessed

“bloodstains on the floor and scratch marks on the walls—evidence of the levels of distress of the women being held there”.

The noble Baroness, Lady Fox, also told the Committee about the experience of prison staff, saying that one of the most difficult things is the danger that prisoners with mental health issues pose to themselves, other prisoners and staff. In fact, Charlie Taylor gave an example of an incident when staff were

“unable to stop one inmate from repeatedly running into a brick wall due to a lack of suitable training”.

These are very important issues that the noble Baroness and other noble Lords are raising.

Given all this and its importance—I know that one of the reasons the Minister was appointed to his position was his experience and passion for prison reform—it seems reasonable to ask the Secretary of State to publish a review of the impact of this Act on prisons and to assess whether it provides for adequate support for ongoing treatment and care in those settings, including adequate staff training. I am sure this will be of help not only to the Secretary of State for the Department of Health and Social Care but to the Ministry of Justice. I look forward to the Minister’s response.

[The Minister of State, Ministry of Justice (Lord Timpson) (Lab)]

I am grateful to the noble Baroness, Lady Fox, for bringing this discussion before the Committee today. This amendment would introduce a new clause, making it a requirement for the Secretary of State to publish a review of the impact and assessment of the provisions of the Act that relate to care and treatment of mentally disordered persons in prisons— this includes under-18s in young offender institutions, IPP prisoners and female prisoners—within 12 months of the day it is passed.

The aim of the criminal justice reforms is to speed up access to specialist in-patient care and ensure that offenders and defendants with severe mental health needs are able to access effective and timely support in the most appropriate setting. We are committed to understanding the impact of these provisions as we monitor any available data. However, these reforms will not come into effect until at least 18 months post Royal Assent. This is to ensure that the necessary operational improvements have been made to enable them to be safely implemented.

We are working closely with health and justice partners to ensure that there is a robust implementation plan in place, and we will scope the feasibility of assessing the impact on all prisoners, including under-18s in young offender institutions, IPP prisoners and female prisoners. Our expectation is that the numbers of these cohorts affected in a prison setting will be small and are unlikely to show up in administrative datasets. However, I reiterate that everyone in our care is important—and I thank the noble Lord, Lord Kamall, for his comments about the importance of this to me. We are committed to supporting everyone’s rehabilitation, working to ensure that people stay out of prison by leaving in good health.

I am pleased with the feedback on the noble Baroness’s visit to HMP Five Wells. I too have seen some very ill prisoners in HMP Five Wells and many other prisons. That is why the Bill, and the work we are doing to improve our prisons and the chances of prisoners leaving with a one-way ticket, not a return ticket, are so important.

I reassure the noble Baroness, Lady Tyler, that there is already a robust scrutiny landscape in place. We are accountable to several key stakeholders and bodies, including His Majesty’s Inspectorate of Prisons, independent monitoring boards, the Care Quality Commission and the Healthcare Inspectorate Wales. We are committed to learning from what works and where we can improve support for vulnerable offenders with severe mental health conditions.

21:30

Separately, other important work is taking place alongside our reforms. The Chief Medical Officer is undertaking an independent review of offender health, which will include young offender institutions, IPP prisoners and female prisoners. This will help us to get a better understanding of the specific health challenges faced by offenders and to work with the Department of Health and Social Care, NHS England and other health providers to improve the support available to them alongside these legislative reforms. Additionally, NHS England will be undertaking a full review of the mental health service specification and pathways of care.

The tragic murder of three innocent victims by Valdo Calocane is simply horrific. The independent criminal courts, including the Court of Criminal Appeal, have passed sentence on Mr Calocane, and the department properly does not comment on the decisions of the independent judiciary. The Prime Minister has announced a statutory and judge-led inquiry into the case. It will look at how different agencies, including health and social services, the police and the criminal justice system work together, and it will examine any multiagency failings that took place in the lead-up to this tragic killing. It will also establish a comprehensive timeline of Valdo Calocane’s interaction with public services.

Addressing the mental health needs of offenders as a critical element of tackling the root causes of offending behaviour, which is of the utmost importance to this Government. I hope this reassures the noble Baroness that we agree on the importance of ensuring that those with severe mental health conditions receive the necessary support and that we are committed to continuing to review and improve this area in future. It is for these reasons that I urge her to withdraw her amendment.

[Baroness Fox of Buckley (Non-Afl)]

Briefly, I say thank you very much to the Minister, the noble Lord, Lord Timpson, who obviously has an intimate and empathetic relationship with the prison estate and the issues that I was raising. I appreciate that he and I share very similar concerns. The difficulty is—I do not think it is just the hour—that the Bill says it will resolve things in relation to prisons but, actually, the discussion around prisons has been rather neglected. I understand why.

The reason I mentioned Mr Calocane is that a lot of the issues in the community and a lot of the public debate about mental health concern the notion of people being ill, wandering around, not being safe and so on and so forth, and I could not think of another way of raising that here. That then affects the prison estate, because people phone the police and then people get taken to prison—or they have been let out of prison when they are mentally ill, and so on and so forth. That is one thing. It requires much greater scrutiny and debate, not just through this Bill but in general in Parliament: that is the first thing. I also think that we have not got public opinion our side on this, in many ways. People are not sure why people are sent to prison in some instances and to hospital in another. I do not expect the Minister to reply, but I think that needs to be acknowledged.

Secondly, I note that, even though I used the example of Five Wells prison, if all the awful things were not happening there, it was based on prison officers’ experiences in many places. I do not want in any way to put the prison into any difficulties, because it is actually doing a very good job in very difficult circumstances. I will just say that I think that, on paper, this Bill will make a small impact, but I think there is much further that it could go. I am glad to hear that different groups will be taken seriously. I withdraw the amendment, but I think we have a long way to go and I will keep pursuing this. I thank noble Lords who spoke in support; I really appreciate that.

Amendment 160A withdrawn.

Amendment 160B

Moved by

[Baroness Tyler of Enfield]

160B: After Clause 50, insert the following new Clause—
“Duty to promote mental health well-beingAfter section 142B of the Mental Health Act 1983, insert—“Duty to promote mental health well-being(1) It is a general duty of local authorities and any body in carrying out functions under this Act or the Mental Health Act 2025 to promote mental health well-being.(2) In carrying out the duty under subsection (1), local authorities and commissioning bodies must have regard to—(a) the prevention of mental illness,(b) the promotion of positive mental health,(c) the reduction of stigma and discrimination associated with mental health conditions, and(d) the provision of accessible and appropriate support services to individuals experiencing mental health challenges.(3) Local authorities and commissioning bodies must publish an annual report outlining the steps taken to discharge their duty under subsection (1), including an assessment of—(a) progress in improving mental health well-being in their area for persons affected by the provisions of this Act, and(b) any barriers to promoting mental health well-being for such persons and proposed actions to address them. (4) The Secretary of State may issue guidance on the discharge of the duty under subsection (1), and local authorities and commissioning bodies must have regard to such guidance.””

[Baroness Tyler of Enfield (LD)]

My Lords, there has been discussion throughout Committee about whether this Bill and our deliberations should stick strictly to detention under the Act or range wider. I know that there are different views on this issue. I have said consistently throughout our debates that we need to see what more we can do to prevent people reaching the point where the only option is being forcibly detained.

I feel that a key omission is a power around prevention. Given the cost of statutory in-patient admissions under the mental health legislation, and the stated intention of the Secretary of State to reduce hospitalisation through prevention, I find this surprising. Therefore, I have brought forward a simple amendment that would give relevant authorities the power to promote mental ill-health prevention in their communities, while of course being realistic about current financial realities.

My Amendment 160B seeks to explicitly grant relevant bodies, including integrated care boards, public health bodies and local health boards in Wales, the power to promote mental ill-health prevention within their communities. It would also empower organisations such as social care and the voluntary sector to take proactive steps in reducing the likelihood of individuals reaching crisis point and requiring detention under the Act.

I was pleased recently to have the opportunity to discuss this with the Approved Mental Health Professional Leads Network, which is very much involved in this. It expressed its support for such an approach. I think we all understand that the causes of mental health issues are complex and can be as much around societal issues, such as employment, housing and poverty, as clinical issues. That is clearly recognised in the AMHP’s role, which acknowledges that while a clinical perspective is always appropriate, other perspectives can be equally valuable. As was explained to me, at the core of the approved mental health professional’s role is a responsibility to explore less restrictive alternatives to detention for individuals in crisis.

As has been quoted a number of times in this Chamber, recently the Secretary of State said that the Government will publish a 10-year plan early next year setting out how they will deliver three big shifts in the focus of the NHS,

“from hospital to community, from analogue to digital, and from sickness to prevention”.

I see this legislation, and indeed this amendment, as an opportunity to make a reality of that statement in relation to mental health. While there will always need to be provision for statutory interventions for those who present a severe risk to themselves or others, it is surprising to me that, in this journey from hospital to community and sickness to prevention, there is no explicit mention of the promotion of good mental health within the Bill.

There is plenty of evidence of the links between prevention and reducing detention. I was going to give some examples, but the hour is late and noble Lords will be pleased to hear that I am not going to. There are also plenty of examples of alternative approaches to detention, such as crisis cafes and safe spaces, community crisis response teams, mobile mental health and social care professionals who respond to individuals in crisis, peer support networks, sanctuaries and respite services. All these have been shown to be effective in reducing the need for hospital admissions.

To conclude, by formally giving relevant bodies the power—it is a power, not a duty—to promote mental ill-health prevention, this amendment encourages a proactive rather than a reactive approach to mental health care and support, thereby, I hope, reducing reliance on crisis interventions, including involuntary detention. I beg to move.

[Lord Kamall (Con)]

My Lords, I thank the noble Baroness, Lady Tyler, for introducing this amendment. It is quite clear that noble Lords across the Committee agree with the Government’s commitment to move the emphasis from sickness to prevention. This amendment is clearly aimed at that, as the noble Baroness has said.

During my time as a Health Minister and since, I have met a number of community and civil society projects, charities and mental health professionals who have shared the amazing work being done across the country to improve the well-being of local communities. I put on record my thanks to the late Baroness Greengross and the noble Lord, Lord Howarth, for introducing me to the wonderful world of creative health and to the National Centre for Creative Health. Its work addresses the theme of earlier amendments from the noble Baroness, Lady Hollins, and the noble Lord, Lord Crisp, on the overprescribing of antidepressants and looking at alternatives. We are not saying that medication is a bad thing necessarily. It is very appropriate in some cases, but there are alternatives, such as social prescribing.

The late Lady Greengross introduced me to a wonderful organisation called Intergenerational Music Making, and I put on record my thanks for its work. It invited me to take part in one of its intergenerational music hubs in Guildford last December and, despite being handed a guitar to play along, I found it inspiring to see the difference that music can make in improving well-being and bringing people of all ages together, including some children from a local learning disability charity.

Noble Lords will also know of the equally amazing work done by many social prescribing organisations, using music, art, drama and green spaces. A career in creative health also opens up new opportunities for budding actors and rock stars who can train as drama and music therapists while waiting for their big break. But many do not wish to be stars and actually find their work, combining their passion with improving mental well-being, fulfilling in its own right.

However, one criticism I hear is that, although there is amazing work on well-being in different primary care settings or in different trusts and integrated care systems across the country, the challenge is how we spread the best practice across our system of health and care, while recognising that what works in one area may not always be an off-the-shelf solution in another locality.

The amendment from the noble Baroness, Lady Tyler —which says that

“Local authorities and commissioning bodies must publish an annual report outlining the steps taken to discharge their duty”


to promote mental health and well-being—may be a way to address this concern. Given that, I hope it is an amendment that the Government will consider. If not, perhaps the Minister can tell your Lordships how the Government intend to encourage the sharing of best practice in improving mental well-being across our system of health and care, particularly across different communities with different needs and different constraints, in order to improve the mental well-being of the nation.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I thank the noble Baroness, Lady Tyler, for tabling Amendment 160B. We recognise the importance of local organisations taking collective action to promote mental well-being and prevent mental ill-health. However, turning to the amendment very specifically, we do not feel that this amendment suggests the best approach, as there is potential for introducing unnecessary burdens on local authorities and commissioning bodies. It may also be duplicative of other existing duties, such as the Care Act duty, to promote individual well-being.

However, the noble Baroness, Lady Tyler, and the noble Lord, Lord Kamall—whom I also thank for his contribution—may be interested to note that the existing prevention concordat for better mental health, a voluntary agreement signed by local authorities and integrated care boards across the country, does involve, for those who sign it, a commitment to take

“evidence based preventive and promotional action to support”

population mental health and well-being.

Through the NHS 10-year plan, which the noble Baroness referred to, and as noble Lords are aware, we aim to encourage stronger partnership working between local government mental health services and the voluntary and community sector—which, as we know, plays a vital role, as the noble Lord, Lord Kamall, described—in order to galvanise that shift, which we all seek, from sickness to prevention. On the basis of the reasons outlined, I hope the noble Baroness will withdraw her amendment.

[Baroness Tyler of Enfield (LD)]

I thank the Minister for her remarks and the noble Lord, Lord Kamall, for his. I am interested to hear about the prevention concordat and hope to hear more about that; I think that could be a useful way forward. Overall, I remain of the view that having something about prevention in this Bill—we have not got it yet—sends out an incredibly important signal.

I am very happy to accept that the way it is currently worded may not be the best and that we could find other ways of doing it. But I would be really disappointed if, in the final piece of legislation, we do not, in some way or another, have something that underlines the importance of prevention. I am not going to go over all the arguments again. I can see us returning to this on Report and, on that basis, I withdraw my amendment.

Amendment 160B withdrawn.

Amendment 160BA

Moved by

[Earl Howe]

160BA: After Clause 50, insert the following new Clause—
“Duty to publish investigations(1) The Mental Health Act 1983 is amended as follows.(2) After section 54A insert—“54B Duty to publish the outcome of investigations(1) Integrated care boards, hospital managers and the relevant authority must, if requested to do so by the court, publish any report, review or investigation that they have undertaken in relation to a relevant patient.(2) For the purposes of this section, a “relevant patient” is a patient who–(a) has received treatment under this Act,(b) is currently receiving treatment under this Act, or(c) has been detained under this Act, andhas been sentenced for a “specified offence” under section 306 of the Sentencing Act 2020.””

21:45

[Earl Howe (Con)]

My Lords, I beg to move Amendment 160BA and will speak to Amendment 160BB. These amendments, tabled in my name and that of my noble friend Lord Kamall, stem directly from the harrowing case of the murder of three people by Valdo Calocane in Nottingham. The Minister and, indeed, other noble Lords may question the propriety of referring to an individual case in this way. However, I believe that this is one occasion on which it is legitimate to do so.

The amendments I have tabled were drafted in the light of the facts that have emerged from the full independent investigation into the care and treatment of Valdo Calocane in the months leading up to the tragic events of 13 June 2023. There have also been press articles on a report by the Independent Office for Police Conduct, the IOPC, which identified 11 mistakes in the run-up to that fateful day. There is a great deal about the case that is known and not disputed, and, given the magnitude of the tragedy, it would be remiss of this Committee not to spend at least a little time considering its implications.

Before I go further, there are two things I need to say. The first is to acknowledge that the Government have agreed to a judge-led public inquiry that will start in a matter of weeks. Secondly, on that account I will do my utmost to avoid saying anything that would undermine that inquiry.

There are a number of issues arising from the treatment of Valdo Calocane that are directly relevant to the Bill because they are of wider application. The report of the independent investigation recounts the timelines associated with Calocane’s treatment. His first contact with mental health services was on 24 May 2020, when he was arrested for criminal damage and a Mental Health Act assessment was undertaken. That assessment indicated that Calocane was experiencing the first episode of psychosis brought on by sleep deprivation and social stressors.

During that first contact, he was not detained for treatment as he acknowledged that he required help for his condition. However, after returning home, Calocane was arrested again and, on admission, was considered not to have capacity to consent and was consequently detained under Section 2 of the Mental Health Act. After that episode of treatment, he was again detained on 13 July 2020, this time under Section 3 of the Mental Health Act. Upon discharge, he was

“considered to have a primary diagnosis of paranoid schizophrenia and was to continue with antipsychotic medication”.

During the course of 2021, Calocane was detained again under Section 2 of the Act and continued treatment in the community. He began missing appointments with his care co-ordinator and mental health care team from July 2022. On 4 August, the care co-ordinator attempted to make a home visit, but the given address was incorrect. On 17 August, the care co-ordinator attempted to reach Calocane at a new address, which received no response.

The report then states:

“On 23 September 2022 it was documented that as no contact had been made with VC, a decision was made at an MDT meeting on the 22 September to discharge VC back to his GP due to non-engagement. A letter to VC’s GP was written the same day, outlining non-contact and that VC had been discharged”.


The key aspect of all this is the problematic last line:

“There was no contact between VC and mental health services or his GP between this date and the tragic incidents in June 2023”.


For a whole nine months prior to the killings there was no contact between any health service and Calocane. What this demonstrates is that the co-ordination of the community aspect of Calocane’s care was clearly inadequate. After he began to miss appointments, it appears that there may not have been sufficient attempts at outreach. There were evidently issues with maintaining contact between mental health services and the patient.

It is this issue that my Amendment 160BB tries to address. The amendment takes the form of a report on continuity of care, to ensure that all options can be explored. I do not profess to have the answers but, as proposed subsection (2) in the amendment makes clear, such a report must include discussion of the possibility of creating some form of duty, placed on ICBs and/or hospital managers, to

“maintain contact with patients known to have a mental disorder”.

This is not too far from one of the recommendations of the independent investigation, which said:

“NHS England and other national leaders, including people with lived experience, should come together to discuss and debate how the needs of people similar to VC are being met and how they are enabled to be supported and thrive safely in the community”.


The point is that, somewhere along the line, the mental health care system failed Valdo Calocane and ultimately his victims and the wider public. As we debate this Bill, we have the opportunity to address these potential failures, in the hope that we can make progress towards minimising the number of patients who slip through the net in this way.

The second issue to arise from the case relates to the publication of the investigation. Noble Lords will remember that controversy arose when the NHS trust responsible refused to publish the full version of the independent investigation into the treatment of Valdo Calocane, due to patient confidentiality. We all know that the NHS did subsequently publish this investigation—I have just referenced it above—but this was not without significant public and political pressure.

There are questions to be answered about whether patient confidentiality rules should apply in cases such as this, where there is a significant public interest. Of course, there should always be adequate safeguards to ensure that a patient’s medical records are protected, but, as my Amendment 160BA sets out, where there have clearly been significant institutional failings regarding a patient who has been treated under the Mental Health Act and who has then gone on to commit a violent offence, it may very well be in the wider public interest for such investigations to be published in full.

I am under no illusion that this amendment is the absolute best solution to the problem. But I hope it at least starts a conversation and pushes the Government to review their approach to publication. There are obviously a number of concerns raised by these harrowing events. We obviously must do better. In the light of the published report, does the Minister believe that there are any measures that could and should be taken now, prior to the report of the judge-led inquiry? I thank the Minister in advance for the considered answer that I know that she will give. I beg to move.

[Baroness Tyler of Enfield (LD)]

My Lords, I rise quickly to say that I am very sympathetic to the aims behind these two amendments. They have been set out very powerfully and comprehensively by the noble Earl, Lord Howe. I feel, particularly, that an obligation to publish a report of an investigation of the type we have just heard about is absolutely essential if we are to avoid a repetition of these terrible events. There must be a way of learning lessons from this, and transparency and publication are an important part of that.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I was pleased to see these amendments as well. The noble Earl, Lord Howe, explained why they are important. He has conceded—I tried to imply the same in my own amendment—that it is not necessarily clear how best to raise these issues, but that we need to. If we are seen by the public discussing a mental health Bill, going through the whole thing and refusing to acknowledge one of the big controversies of recent times, which was a mental health issue, it will discredit the Bill when it becomes an Act.

In relation to the reluctance of the NHS trust to publish its investigation and the use of patient confidentiality, I note that the families of the victims saw this very much as an excuse and were very angry about that. It does not help us to have a discussion with the public about mental illness because it then seems as though murder was committed but, somehow, mental illness was used as an excuse. We have all heard that argument being used; that is why I referred to the fact that there was some dispute about whether Calocane should be sent to prison or to hospital. The more openness that we can give this, the less stigma and confusion there will be. We need to have this debate out in the open.

Finally, I have a question on the judge-led inquiry and what we now know from the investigation by the trust. How will that impact this Bill? How, practically, will we be able to incorporate what we have learned from that into our discussion on a whole new piece of legislation on mental health? It would seem that we need to be able to take on board some of the recommendations of the inquiry and what we now know from the investigation by the trust.

[Baroness Merron (Lab)]

My Lords, I thank the noble Earl, Lord Howe, for tabling Amendments 160BA and 160BB, supported by the noble Lord, Lord Kamall, and spoken to by the noble Baronesses, Lady Tyler and Lady Fox.

I say at the outset that I understand the deep concerns raised today by noble Lords. I would like to take this opportunity to express my sincere condolences, and I am sure those of the whole of your Lordships’ House, to the families of Grace O’Malley-Kumar, Barnaby Webber and Ian Coates. The Secretary of State and I have met the bereaved families following these horrific killings, and, rightly, important actions have been taken, which the noble Earl, Lord Howe, asked about. Indeed, we have to look at what improvements must be made, both at the trust and across the country.

To take this further, NHS England and the Nottinghamshire Healthcare NHS Foundation Trust have accepted all of the recommendations made following the Section 48 CQC review into this incident, and action has started on implementation. The recently published independent investigation into the care and treatment provided to Valdo Calocane makes a series of recommendations, which NHS England and the Nottinghamshire Healthcare NHS Foundation Trust have accepted. I reiterate that the Government expect to see swift action to ensure that the recommendations are implemented as soon as possible. As the Prime Minister has confirmed, and as the noble Earl, Lord Howe, acknowledged, there will be a judge-led, statutory public inquiry into this tragic incident.

I now turn specifically to the amendments, and first to Amendment 160BA. We recognise the importance of transparency when there are concerns around a patient’s care, to enable a full understanding of what went wrong and how learning can be applied as a result. The courts already have legal powers to request, and where appropriate compel, disclosure of relevant reports, ensuring judicial access to relevant information. In criminal and civil proceedings, courts can make orders that particular information be provided, or issue witness summonses, while coroners can obtain documents as part of an inquest. There is no clear evidence that courts face systemic barriers in accessing necessary information.

There are also existing mechanisms to provide robust oversight and transparency. NHS England’s patient safety incident response framework sets out clear guidelines for responding to serious incidents involving patients who are detained under the Mental Health Act. Additional scrutiny is provided through investigations by the Health Services Safety Investigations Body and oversight from the CQC.

If information is not disclosed, interested parties already have mechanisms to access information, including judicial review, freedom of information requests and the coronial process for deaths in detention. While courts have the powers set out in the amendment, we absolutely recognise the importance of openness in mental health services, which is why officials are working with NHS England to ensure that information from investigations is as transparent as possible—something that all noble Lords have rightly referred to.

22:00

Specifically on the publication of the independent investigation in Nottinghamshire, NHS England was following the legal advice it had received in relation to publishing the report. However, considering the strong wishes and feelings of the victims’ families, the decision not to publish the full report was reviewed and a risk-based decision was taken to publish the full report in this particular case, as much of Valdo Calocane’s medical information was already in the public domain.

On Amendment 160BB, I agree that good continuity of care is vital, and improving that is a key objective of these reforms. The Bill introduces statutory care and treatment plans that aim to ensure that patients have a clear and personalised plan in place to progress them towards recovery. We intend the plan to cover how the patient will be supported and the services they will need in the community after discharge, and the content of the plan will be set out in regulations. We will commission an independent evaluation of the impact of these reforms and therefore do not feel that a separate report is required.

More broadly, the community mental health frame- work is intended to help remove what are referred to as cliff edges of care between secondary and primary care services. That includes a named key worker for all service users, with a clearer multidisciplinary team approach to both assess and meet the needs of service users.

I turn to the specific point about a duty to maintain contact with patients known to have a mental disorder. Where a patient does not engage with treatment, community treatment orders already exist to ensure that patients comply with treatment for their mental disorder in the community. Following the horrific killings in Nottingham, NHS England has asked all ICBs, through the 2024-25 planning guidance, to review their services to ensure that they have clear policies and practice in place for patients with serious mental illness who require intensive community treatment and follow-up but where engagement is a challenge. To support system reviews, NHS England has also published guidance setting out the key principles in this area that should be reflected in local policies and practices. In addition, I can confirm that the NHS England national director for mental health has written to all ICBs to make clear that it is vital that “did not attend”, DNA, is never used as a reason for discharge from care for this vulnerable patient group. For these reasons, I urge the noble Earl not to press these amendments.

[Earl Howe (Con)]

My Lords, I am grateful to the noble Lords who have spoken in this debate. While the Calocane tragedy provided the trigger for these amendments, there are messages sent out from that case that are of wider and more general application that it would not be inappropriate for the department and NHS England to think about now, and I am glad that such consideration is being given as we speak. I recognise that there are established processes set out in the community mental health framework, among other places, but those processes clearly failed, which is why the Calocane case is such a seminal one.

The inquiry will no doubt shed further light on who bears responsibility for what happened, but that is not my concern today, as I am sure the Minister will appreciate. My concern is that practical steps could be taken, perhaps in the areas of professional training, updating the code of practice and the revision of standard referral protocols—the Minister has spoken broadly about those sorts of things, which I very much welcome. I will give further thought to this very vexing set of issues between now and Report but, for now, I am content to withdraw the amendment.

Amendment 160BA withdrawn.

Amendments 160BB and 160BC not moved.

Clause 51: Power to make consequential provision

Amendment 160C

Moved by

[Baroness Tyler of Enfield]

160C: Clause 51, page 63, line 29, at beginning insert “Other than provision mentioned in subsection (5),”

[Baroness Tyler of Enfield (LD)]

My Lords, I will speak to Amendments 160C and 160D in the name of my noble friend Lord Scriven. These amendments would ensure that any changes to this primary legislation implemented through secondary legislation were properly considered by Parliament before they took effect.

Amendment 160C makes it clear that certain provisions in subsection (5) should not be included under the general powers in Clause 51, and Amendment 160D then strengthens parliamentary oversight by requiring that any statutory instrument amending or revoking this primary legislation be approved by both Houses before it comes into force; that is, by using the affirmative procedure.

This is a matter of proper scrutiny. Primary legislation is carefully debated before it becomes law, as we have demonstrated throughout this Committee stage, and any later changes to it should not be made too easily or without full consideration. If a statutory instrument can amend or remove part of an Act without Parliament’s approval, there is a risk that important legal protections could be altered without proper deliberation.

This is particularly important in the context of mental health legislation, where the law directly affects the rights, personal liberties, and treatment and care of highly vulnerable people. I hope that the Government will recognise that these amendments, which are completely in line with the recommendations of the Delegated Powers and Regulatory Reform Committee, simply ensure that when primary legislation is changed, it is done with the same level of scrutiny that was given to it in the first place. I beg to move.

[Earl Howe (Con)]

My Lords, I will keep this brief since I can do no more than back the noble Baroness, Lady Tyler, in every word that she has said in support of these two amendments. We are dealing here with a Henry VIII clause that is surely far too permissive given the great sensitivity of the Bill’s entire subject matter and, as the noble Baroness said so well, its momentous significance for the health and well-being of very vulnerable people.

The absolute minimum that Parliament can expect is that Parliament be consulted in the exercise of these powers. The affirmative procedure is therefore entirely appropriate for any statutory instruments made under this clause and I hope the Minister will not disagree with what is proposed.

[Baroness Merron (Lab)]

My Lords, I thank the noble Lord, Lord Scriven, for tabling Amendments 160C and 160D, which were introduced by the noble Baroness, Lady Tyler, and spoken to by the noble Earl, Lord Howe.

The proposal in the amendment, as was referred to, was a recommendation in the report from the Delegated Powers and Regulatory Reform Committee. I hope that your Lordships’ Committee will welcome that we are actively considering this proposal and will publish our response to the committee’s recommendation ahead of Report.

[Baroness Tyler of Enfield (LD)]

My Lords, I very much welcome the statement we have just heard from the Minister. I think it is a good point on which to finish our deliberations tonight and I thank her very much. I also thank the noble Earl, Lord Howe, for his support. I beg leave to withdraw the amendment.

Amendment 160C withdrawn.

Amendment 160D not moved.

Clause 51 agreed.

Amendment 161

Moved by

[Baroness Merron]

161: After Clause 51, insert the following new Clause—
“Power of Welsh Ministers to make consequential provision(1) The Welsh Ministers may by regulations made by statutory instrument make provision that is consequential on this Act.(2) The only provision that may be made by virtue of this section is provision that would be within the legislative competence of Senedd Cymru if contained in an Act of the Senedd.(3) Regulations under this section may amend, repeal or revoke provision made by or under primary legislation passed—(a) before this Act, or(b) later in the same session of Parliament as this Act.(4) In this section “primary legislation” means—(a) an Act, or(b) an Act or Measure of Senedd Cymru.(5) A statutory instrument containing regulations under this section is subject to annulment in pursuance of a resolution of Senedd Cymru.” Member's explanatory statement
This confers a regulation-making power on the Welsh Ministers to make consequential provision that is within devolved legislative competence. The Secretary of State has an equivalent power under Clause 51.

Amendment 161 agreed.

Clause 52 agreed.

Clause 53: Commencement

Amendment 162

Moved by

[Baroness Merron]

162: Clause 53, page 64, line 2, leave out “33, 34,” and insert “29(2), 31, 33, 34(1) and (3)(b),”
29(2)
34(1)
(3)(b)
Member's explanatory statement
This amendment would provide for certain provisions currently commenced by regulations to be commenced two months after Royal Assent (and vice versa).

Amendment 162 agreed.

Amendments 163 to 164 not moved.

Clause 53, as amended, agreed.

Clause 54 agreed.

House resumed.

Bill reported with amendments.

House adjourned at 10.12 pm.