Lords Chamber

Monday 24th November 2025

(began 1 hour, 52 minutes ago)

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Baroness Merron Portrait Baroness Merron, The Parliamentary Under-Secretary for Health and Social Care (Labour)
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work by the Wheelchairs Alliance in the all party group on wheelchairs would suggest that if you leave this to UN bodies and local authorities, they simply will not improve the current inadequate and improve the current inadequate and patchy service. My Lords, the all party group on Access to Community Equipment, have reported that 63% Equipment, have reported that 63% of carers and 55% of equipment users, saying that services are getting worse. Someone else could I ask my noble friend, given what she said about the quality framework, said about the quality framework, which I very much welcome? Does she accept that nothing will change accept that nothing will change unless this is enforced from the centre with strong performance management? management? I do accept the observations that my noble friend has made, and I know he's been a voice on this for many years, and I share with him the impatience for change and welcome the work of the APPG and the Wheelchair Alliance.

What I would say to him is that the NHS Medium Term Planning Framework, Medium Term Planning Framework, which was published just in October, does require that from 20 2627, all does require that from 20 2627, all icbs and community health services must actively manage and reduce the must actively manage and reduce the proportion of whites across all community health services over 18 weeks and develop a plan to weeks and develop a plan to eliminate all 52 week waits. And I would expect that wheelchair would expect that wheelchair provision and services will improve through this, as well as other means.

means. My Lord, my Lord, my Lords. statistics in relation to people that have to stay in hospital and avoiding discharge because of the length of time taken to get

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wheelchairs. I would be pleased to write to the noble Lady about the specific the noble Lady about the specific data that's available. But of course, we do know that because of issues to do with Aids and adaptations, sometimes people's people leaving hospital is not as people leaving hospital is not as timely as it should be. That is not in their interests. And certainly in their interests. And certainly we do expect local authorities, for example, to have a statutory duty to make arrangements to do so, and to make arrangements to do so, and also for ICBs to make the provision.

So there aren't the hold ups that
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Baroness Merron Portrait Baroness Merron, The Parliamentary Under-Secretary for Health and Social Care (Labour)
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Well, this is a very important point, including about, in fact, the supply chain and also the technology that that there is, and particularly if we're thinking about those with more complex needs, about those with more complex needs, the wheelchair has to support and meet those complex needs. We do know there's a lack of investment in new models, and we do know that there's been disruption in the there's been disruption in the supply chain. And whilst I don't seek to blame it, that was a particular issue arising out of the particular issue arising out of the pandemic.

So we are indeed working pandemic. So we are indeed working on better technology in terms of wheelchairs and other aids and adaptations, and also seeking to adaptations, and also seeking to iron out where there are difficulties in people making bids for contracts. But if the noble Lord has particular examples, I'd be very pleased to hear about them. My Lords, is my noble friend able to comment on the problem which carers often report of being unable to return the wheelchair to its source once it's no longer

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needed. My noble friend raises a point that again applies not just to that again applies not just to wheelchairs, but other aids and adaptations. And there is indeed a adaptations. And there is indeed a very considerable issue. We that is a matter for local services, but it a matter for local services, but it is absolutely something that we will work with them on as part of how we improve services, because it how we improve services, because it also includes the safe and timely return.



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return. My Lords, as well as the concerns raised by the noble Lord Lord hunt about NHS wheelchair services. We know that in addition to that, there are over a million wheelchair users of different types
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None Portrait Oral questions: Improving the scale of research into the causes and treatment of brain tumours Baroness Mattinson (Labour)
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My Lords, I thank the noble Lady, the Minister, for her reply, but I do want to press for more urgency to beat this terrible disease. Brain cancer is now the biggest
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None Portrait Legislation: Mental Health Bill – consideration of Commons amendments and/or reasons Baroness Merron (Labour)
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considered. Question is that the Commons amendments be now considered. As many as are of that opinion.

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As many as are of that opinion. Will say content the contrary, not content. The contents have it

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amendment one Baroness Merron. My Lords, I beg to move that the House do agree with the Commons in their amendment one with the leave of the House. I will also speak to amendments 2 to 21, including motions 19 A and 19 D. My Lords, it is a pleasure to return this Bill to this House, where I do very much appreciate the support and engagement of noble Lords throughout its passage. Let me turn first to the government amendments.

In the other place, other than the minor and technical amendments which are there for clarification, my Lords, we have clarified duties on NHS bodies to make arrangements regarding advanced choice documents, otherwise known as acds. NHS bodies must actively inform individuals about acds rather than taking a minimal approach. The Bill requires that information and help is provided to people who wish to make a CD through discussion with a suitably qualified person. NHS bodies should consider the advantages of making an ACD within 12 months after discharge, and aim to provide support and additional guidance on these duties will be in the revised code.

My Lords, I would like to thank my noble friend Baroness Keeley and the noble Lady Baroness Barker for raising concerns about the unequal application of the Human Rights Act. The government has now made it so that registered private providers delivering section 117 aftercare or inpatient mental health services funded by local authorities or the NHS, are now treated as carrying out public functions under the Human Rights Act and Act Compatibly with the convention rights, and this amendment will apply UK wide.

Turning now to amendments made by this House on police powers, let me thank the noble Lady Baroness May for her constructive engagement and also for establishing the review of the mental health bill when she was Prime Minister, which has brought us to this place today. We have removed amendments made to clause five, which added police and other authorised professionals to sections two, three and five, extending police and other authorised professionals to these sections is inappropriate, a view that is shared by the police.

We have removed clause 50 from the bill, which extended emergency police powers under section one, three five and 136 of the act to other authorised persons. Health and care professionals lack the training, the equipment and the access to rapid backup needed safely to use such powers, and stakeholders are concerned about staff having authority to use reasonable force. A blanket extension of powers to multiple agencies risks confusion and delay in emergencies due to a lack of clarity on who should respond.

My Lords, there are strong views on either side of this issue, and there are situations where health professionals feel they do not have the powers that they need. That is why I am announcing longer term plans to launch a consultation into emergency police powers of detention. We will consult to look at the powers available to different professionals in different situations and settings in particular, but not limited to looking at the operation of sections one, three, five and 136.

Emergency powers. The consultation will seek views on powers and joint working approaches to ensure that health and social care professionals and police have the appropriate powers in order to to act in order to prevent people from harm to themselves and to others when in a mental health crisis. We do firmly believe that this is the right approach to a complex issue that requires careful consideration and consultation. My Lords, turning to community treatment orders, clause six, paragraph three has been removed from the bill as community treatment orders, known as CTOs, already comply with the code and have an initial six month period.

The responsible clinician may renew a CTO if there is a risk of serious harm. Without it, and reasonable prospect of therapeutic benefit. Following positive engagement with the noble Lord Lord Scriven and the noble Lady Baroness Tyler, I can confirm the government will review the statutory forms which relate to CTOs, with the aim of strengthening them to ensure a clear audit trail of the reasons for applying a CTO and associated conditions. Regulations will require statutory care and treatment plans, specify any CTO conditions and their justifications, which will also be clarified in the code.

We will work with the Tribunal Service and the judiciary to ensure the patient's plan is considered, alongside other evidence at tribunal hearings. We will clarify in the code that where the tribunal recommends, the responsible clinician reconsiders CTO conditions as they don't consider them necessary, the responsible clinician should review and potentially revise these conditions. Those conditions. The code will set out that the responsible clinician should inform the patient of their decision. After considering the tribunal's recommendation, which should be recorded in writing.

We will engage on the code before publication and involve Lord Scriven and Baroness Tyler in the process. As the tribunal is responsible for considering all relevant evidence. This may include recent recommendations made at past tribunal hearings regarding the conditions placed on the person, including the detail and rationale of any current conditions. I can confirm that since September 2025, we have increased the quantity and frequency of reporting on racial disparities in key metrics such as detention, CTOs, and length of stay by ethnicity.

Much of this data was previously published annually, but it is now monthly, allowing closer monitoring of progress. The data is publicly available on the Mental Health Act annual dashboard, and, along with implementation of the Patient and Carer Race Equality Framework, will be used by CQC. The Care Quality Commission as part of their inspection regime. Turning now to the debriefing amendment, I thank the noble Lords, Earl Howe and Lord Cromwell for their constructive engagement. We have removed clause 35, which required independent mental health advocates to consult people about their inpatient experience after discharge.

This removes policy duplication and additional strain on advocacy services whose focus is supporting detained patients rights. The code will clarify the processes of care planning, supporting someone to make an advanced choice document should include the opportunity to reflect on past experiences, and the ten year health plan commits to making patient feedback central to quality improvement. And finally, my Lords, the government has tabled amendments in lieu regarding the appointment of a nominated person for a child under 16 who lacks competence.

And I am most grateful to the noble Lady Baroness Berridge for her continued work on this. The bill now states that an approved mental health professional, or AMP, must appoint either a person who has parental responsibility, a person named in a Child Arrangements Order as a person with whom the relevant patient is to live, or a person who is a special guardian. If there is no suitable person willing to act. The AMP must consider the child's wishes and feelings when deciding who to appoint.

Turning now to the amendment tabled by the noble Lady, Baroness Berridge, to the government's motion, I understand the intention to prevent a parent who has had parental responsibility limited from being appointed as a nominated person by an amp, where a child lacks competence to make the appointment the amendment tabled would mean a special guardian or person named under a child arrangement order. As someone with whom the child must live, must be appointed. It is not appropriate for legislation that a particular individual must always be appointed nominated person, if they are not able or even willing to perform the role effectively, then requiring them to take this role and ruling out other options risks harming the child's interests.

Legislation, my Lords, as we know, can be a blunt tool. It is far more appropriate to set out nuances like this in statutory code to ensure the child's individual needs are considered. That is why we previously agreed to set up an expert taskforce to consider these very complexities. Part of this role includes ensuring clear guidance is given to Amps on who to appoint in a range of scenarios to avoid unintended consequences. My Lords, at this late stage, in order to get this right, we should not be hurriedly working through these complexities as a part of the legislation, but should develop detailed guidance and consultation with professionals and patients through drafting the Code of practice.

I therefore ask the noble Lady to withdraw her amendment. My Lords. In conclusion, I hope noble Lords will support our position and

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pass the legislation without amendment. I beg to move. The question.

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The question. Is that the House do agree with the Commons in their amendment one. My Lords, I. Rise to.

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Rise to. Speak to amendment 19 in my name, and I want to thank the noble Lady, the Minister and her officials for the frequency of their engagement on this bill. And I want to put on on this bill. And I want to put on record my apology for not spotting possible issues with the government's motion much earlier, government's motion much earlier, when to which I have laid the amendment. And I do thank the noble Lady and her officials for meeting with the approved mental health with the approved mental health practitioners, which are the professional group, often late at night or at a weekend, who are dealing with our sickest children, dealing with our sickest children, who do not have the competency to appoint a nominated person for appoint a nominated person for themselves.

And I specifically recognise the inconvenience to the Bill team. But this matter relates Bill team. But this matter relates to child protection of mentally ill children and has been flagged at every stage since the Wessely review in 2018, when a consultation was suggested. In recent meetings was suggested. In recent meetings with the noble Lady, the Minister, I understood that what was to be achieved was that the appointment achieved was that the appointment of nominated persons would reflect existing court orders made by the
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Baroness Berridge Portrait Baroness Berridge (Conservative)
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Family Court on child protection grounds. The mischief, really that the approved mental health practitioners want to solve is that they do not want to have any they do not want to have any discretion to appoint a nominated person, anybody that is not in accordance with an existing court accordance with an existing court order. This is what they want to see achieved through the mandatory see achieved through the mandatory appointment of the special Guardian in priority to anybody else. The in priority to anybody else.

The rationale being that special guardianship is usually used to avoid care orders, adoption or long avoid care orders, adoption or long term fostering in relation to a care order. I am grateful that His Majesty's Government amended the Bill to mandate that the appointment of the nominated person in those circumstances must be the in those circumstances must be the local authority and the local authority alone. So why does in this bill the same rationale, I would say, applies to special guardians? Why the Children Act is clear that parents, if a special guardianship order is made by the Family Court, only have parental responsibility for things like leaving the jurisdiction for more than three months or surname than three months or surname changes.

It is neutered. Parental responsibility as apparently now the word used. Why? Because the parents. Sometimes it's due to illness or neglect, or sadly, it's because they present a danger to the children themselves. And that is why the authority of the court has limited their parental responsibility. It is, of course, open to a parent to apply for leave to the court, to disapply the special guardianship and regain full parental responsibility. If, say, for instance, they've recovered from an illness. So turning to His Majesty's Government, motion A, B and C are all people who have got parental responsibility.

So what do paragraphs B and C actually add to the government's motion? There is in drafting and I don't know the full significance. There's no or at the end of those those paragraphs. So is that that everybody gets appointed and they must be appointed. It seems rather confusing. There is also not, in the words of the motion, one of the following. It does say if a person is willing. But then there is no priority within A, B, and C, so there's no order of precedence within the motion.

What I had understood also, and I'm afraid to correct the noble Lady, the Minister. It is mandated already in law in section 28 of the Mental Health Act, that when there is a special guardianship order and when there is a child arrangements order, living with there is no discretion. Does it matter the surrounding circumstances? Does it matter whether these people wish it is mandated that they are appointed as the nearest relative in preference to anybody? They are deemed nearest relative in preference to the exclusion of everyone else.

There's no issues that I've been made aware of, of people being unwilling to act as that nearest relative, or that there are different circumstances. If, of course, the AMP is presented with that situation. What is the solution to second guess the court order, or within 24 hours to go to the family court and get the special guardianship Order or the Child Arrangements Order that's to live with amended. And I am assured by Amps that unlike many of the other lists in the county court, you do actually get heard within 24 hours or so because of the urgency.

So I emphasise the amps do not, whether in code or on the face of the bill, want to have any discretion to go behind an order of the court. And if if someone being unwilling to act in the in the noble Lady mentioned also in her letter, there doesn't seem she's now outlined that the child's wishes are taken into account. But if there is no one with parental responsibility willing to act, what is the solution? It doesn't seem to be within the bill, and so I can't quite understand the emphasis now being placed on it.

The reason that, as I understand it, that His Majesty's Government laid the motion was because statutory guidance cannot mandate anything unless it's on the face of the bill. But the question then arises for us to consider is actually the reverse true statutory guidance undo what is on the face of the bill? Does this mean, in practice, that the malevolent parent who's swinging the lead and telling the amp at 3 a.m. in the morning that the very sick daughter has been living with him for three years, and actually the special guardians no longer involved and is now armed with the Mental Health Act to say you have a duty to appoint me.

So His Majesty's Government's motion mandates that if if this person is willing to act, they must be appointed. So to what extent can the Guardian the guidance, undo that? This potentially gives them a hugely significant role back in the child's life that the Family Court deemed they should not have inadvertently, is His Majesty's Government. Whilst seeking to amend and close the loophole opening up such a possibility. And sadly, I view that at the moment the bill is defective.

Hence I laid the amendment to the motion. I recognise it's not appropriate to divide, but we do have to go. We have some time before the bill then has to go back to the Commons to try and sort out. What I'm informed by amps is still confusion, and I do regret that they, the Experts in Children Act and Mental Health Act, did supply an amendment to the noble Lady's department and didn't seem to have had a reply. So I do hope that in response, the noble Lady will be able to reassure me that statutory guidance can do more than I think it can.

But I do think we need to take these final moments with this bill to protect the thankfully small number of children. But in these most vulnerable situations.

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So I'm very grateful to the noble Baroness, the Minister and her officials for the interaction her officials for the interaction that they've had and many discussions we've had in relation to the matters posed in the to the matters posed in the amendments that I originally put down to the Bill in relation to powers of police and the possible powers of police and the possible extension of some of those powers to authorised professionals, including healthcare professionals. including healthcare professionals. And I'm also grateful to the noble Baroness, the Minister and the government for agreeing to the government for agreeing to the review and consultation in relation to the exercise of powers, not simply those in sections one, three, simply those in sections one, three, five and one, three, six, but but the general exercise of powers between police and healthcare professionals and other authorised professionals.

And I have a number of questions about that review. But
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Baroness May of Maidenhead Portrait Baroness May of Maidenhead (Conservative)
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of questions about that review. But before I come to those questions, I hope the I can crave the indulgence of the House. Just to cite a couple of the examples of what is concerning me in relation to powers, because I think often people go to the sort of situation in which there's a real threat, a risk of violence, or a risk of danger to those who are exercising powers of restraint. But actually there are other issues. And the noble Baroness did, in her opening remarks when she was moving the government motion, refer to the fact that there are indeed some concerns among healthcare professionals, as well as among police, about the exercise of these powers.

So one situation might be if a patient presents to a GP in a mental health evident mental health crisis, the clinician determines an urgent assessment is needed. The patient may be advised to attend hospital voluntarily, but if they are unwilling to do so and there is no other available alternative statutory pathway, then the police will be contacted in order to exercise their powers. Under section 136. It's not that the police are needed, but it's just they're the only person who's got the power at the time.

There isn't necessarily a need to restrain somebody, but they're just the only person who has that power. The other circumstance might arise in an accident and emergency department, where if a patient is identified as requiring hospital admission for mental health care, but if the individual attempts to leave before an approved mental health professional or a second assessing clinician is available or bed is found, then the emergency department staff have no statutory authority to prevent their departure, the individual's departure, and they ring the police for assistance.

And in evidence to the Joint Home Office and DHSC review, which was reported in 2014, there was evidence of this. Doctor Beale said. A police officer has more power in that situation than I do. How can I excuse calling the police to my department to assist in mental health care? We want to reduce the involvement of police and mental health care, not invited. And I am sure we are all agree that we want to ensure the best possible pathway and experience for the person with mental health problems.

We want to reduce the use of police resource and we want to improve the policing of communities because the police officer required to attend unnecessarily a mental health incident a mental health patient is a police officer taken off the policing of their local community. And so my questions are will the review ensure that it also looks at the evidence that was given to the the review that reported in 2014, which, among other things, showed that 93% of paramedics agreed with extending section 1.335 and 136 powers to remove a person to a place of safety, to extending it to other professionals provided they were trained and equipped.

What is the timeline for the review and consultation? I'd like it to be something like six months, at which department will be the department running the review or responsible for the review? I think it should be again, Joint Home Office and DHS see review and what happens at the end if it identifies a need to extend these powers to or add healthcare professionals to the list of authorised professionals, will the government guarantee to undertake that, and what vehicle would they use to do so? So once again, I'm very grateful to the Minister for the discussions we've had, but I would just like to be
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