Mental Health Act 1983

Baroness Barker Excerpts

Tuesday 21st November 2023 Lords Chamber

[Lord Markham (Con)]

We are all agreed on the intent behind what we were trying to do with the Bill. On learning difficulties and autism, the most important thing we are trying to do is to make sure that the CQC, within 48 hours of a person being put into segregation, is investigating and doing an independent review on whether that is the best place for them. Like the noble Baroness, I share the feeling—we all think it—that it is much better that they are treated in the community, where they can be.

[Baroness Barker (LD)]

My Lords, mental health legislation relies on good data; we do not have good enough data about the detention of people from different groups. Does the Minister agree with the committee that a step forward that could be taken now is the appointment of a responsible person in each organisation with a duty to record not only the detention of people under the Mental Health Act but the demographic data surrounding it?

[Lord Markham (Con)]

Yes. The data, and fundamentally understanding what is beneath it, is key to all this. We have put an executive lead on each trust board to look at exactly these sorts of issues, including the data, so I am happy to take that forward.

Autism: In-patient Care in Mental Health Hospitals

Baroness Barker Excerpts

Tuesday 14th November 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness for her report and the meeting that we had to follow it up. Probably the best way forward on this is that a lot of things we are doing and can do can be done absent the Bill. I should be happy to sit down with her and talk through what we can do and where we can go further to make sure that everything that we were trying to put into legislation we can effectively make happen anyway, because we are all agreed as a House absolutely on the direction of travel in which we want to go.

[Baroness Barker (LD)]

My Lords, what is being done to change the commissioning systems and contracts that currently incentivise providers of medium and long- term secure accommodation to keep people in hospital, rather than equip them to go back into the community?

[Lord Markham (Con)]

I will come back in more detail on the contractual arrangements, but the point that the noble Baroness raises on making sure that there are no perverse incentives to do that has to be right. The now CQC-led reviews that we have agreed to put in place as part of continuing the recommendations of the noble Baroness, Lady Hollins, happen frequently. In the case of adults, there is a review every six months, if appropriate, and, in the case of children, every three months to make sure that every step of the way we ask whether this is really the right place for them to be.

King’s Speech

Baroness Barker Excerpts

Thursday 9th November 2023 Lords Chamber

[Baroness Barker (LD)]

My Lords, a gracious Speech is a helpful indicator of a Government’s position and their intended programme for the coming years. This speech is quite clear: it is a series of individual bits and pieces with not a strategy in sight. That is something we should pay a great deal of attention to when we think about the run-up to the next election because we are desperate for a Government who will take seriously the issues facing all our public services, addressing the growing demands on them and the likelihood that there will be fewer resources in real terms to provide them.

I spent the last two years in various Select Committees of your Lordships’ House—one on social care, one on scrutinising the mental health Bill and one, which is about to conclude, on the integration of community and primary care. Across those three pieces of work, there have been a number of recurrent themes.

The most fundamental to this is the need for an informed public debate about sharing personal data. Our personal data will be the basis on which the future of health and public services is built. At the moment, we have a great deal of confusion, not least on the part of practitioners, about the status of data protection laws and the importance of public health. Time and again in those different committees, we heard frustration on the part of practitioners, service planners and patients at the utter impossibility of getting data on individuals, or even at a community level, in a manner that is timely and makes for the effective and efficient provision of services.

I wonder whether the Minister will take from this the urgent need to revisit the Caldicott principles and update them in the light of technological information advances, and to begin the process of having a public debate about the ethics and principles of sharing data. In that way, we might move quickly towards an improved performance of public services, particularly health and social care, based on the resources that we have at the moment.

It is regrettable and a great shame that the Government have turned their back on the widespread consensus on how mental health law should be reformed that has developed since Sir Simon Wessely produced his report. Nevertheless, a great deal of work has been done, which will be there waiting for an incoming Government to do it.

There are three things that the current Government should do now, which do not require legislative change. First, there should be mandatory training for all mental health professionals in the recognition and diagnosis of autism and learning disabilities. That would stop the inappropriate treatment of people with learning disabilities and autism, which sometimes not only leads to them being inappropriately detained at length under mental health legislation but results in them going into the criminal justice system when they should not.

Secondly, with a number of long-term conditions such as Parkinson’s disease, there is a great incidence of mental illness. I wonder whether the Minister will look at the major conditions strategy and the need to make sure that practitioners, in certain physical conditions, understand the mental health aspects of those conditions.

Finally, when we worked on the mental health Bill, we looked time and again at the disproportionate effect of mental health legislation on people from black and brown communities. They are far more likely to be detained inappropriately than other groups. We were told by all the people to whom we spoke that one thing that would have a direct impact on that is the introduction of an electronic system of advance choice documents. Advanced work is being done on that, based on work done in the field of palliative care by people at South London and Maudsley, the psychiatrists at Guy’s and so on. It needs only the Minister’s department to swing in behind the work already being done for pilots to be rolled out, ready for an incoming change in the legislation.

Let us be honest: none of us can see a time when local authorities will suddenly have new, massive amounts of money to put into social care. It is already underfunded and is subsidised by individuals. The one key thing that the Government could do is make sure that local government retains the requirement to give people assessments of their needs and to tell them what is available to them, wherever they choose to get their help from. Funding those independent assessments, and not leaving it to providers of services, is the one critical thing that might make a difference to the increasing number of people who will be living in the community with long-term conditions and really need help to stay in their homes—which I hope will be built to a lifetime standard in the future, so that people can stay in their home whatever the tenure of the home in which they live, whether rented or private.

I take the opportunity to say one final thing: King’s Speeches are about Governments’ priorities and choices. When the Government can find the time to license pedicabs but cannot be bothered to bring in a ban on conversion therapy, the lesbian and gay community understands the message. We get it: we are not safe while this Government continue to be in office. It is absolutely time that they went.

National Health Service: Major Conditions Strategy

Baroness Barker Excerpts

Monday 18th September 2023 Lords Chamber

[Lord Markham (Con)]

The strategy tries to provide a road map for how we want to do this. It starts with prevention, which I think we are all agreed on, then early diagnosis, quality treatment and then living or dying well with that condition. It is a philosophy: the idea is that we get it right in these six major areas with 60% morbidity, and then we roll it out across the board in all other areas. It is a way of treatment, really—a way of looking at the whole problem, centred around whole patient needs, that we will roll out to other conditions as well.

[Baroness Barker (LD)]

My Lords, if this is to become a reality rather than an aspiration it will require a huge increase in the number of community nurses. How do the Government think that will happen when the main incentives and career development for nurses lie within the acute sector?

[Lord Markham (Con)]

My Lords, the noble Baroness is absolutely correct. That is set out in the long-term workforce plan: a move much more upstream to prevention and primary care, of which community nurses will be a key part. The recruitment is in place for it all. Yes, a lot of people might see the action as being in the acute sector, but a lot of people really enjoy working in the community as part of their lifestyle. The hope and expectation is that it will appeal to a lot of people in those areas as well.

Social Care

Baroness Barker Excerpts

Thursday 30th March 2023 Lords Chamber

[Baroness Barker (LD)]

My Lords, I have had the privilege of being a member of the Adult Social Care Committee, chaired by the noble Baroness, Lady Andrews, and I am now a member of the Select Committee on the Integration of Primary and Community Care, chaired by the noble Baroness, Lady Pitkeathley, so I have come to think of the noble Baroness, Lady Shephard, as my partner in crime on both of those, as we question a series of professionals coming in to try to tell us just how bad the situation is currently.

We are having this discussion in the run-up to a general election, nearly a decade on from the passing of the Care Act and more than two decades on from the royal commission on the future of long-term care, and I suspect we are no nearer a resolution now than we were then. But I think it is important, as we are in the run-up to a general election, to make a few recommendations to all those people in political parties who are drawing up their manifestos.

The first is that there needs to be an update of the Dilnot commission proposals. We need a realistic assessment of the needs of older people and adults with disabilities for long-term care and the extent to which that can be funded by individuals’ capital assets. A crucial element of that assessment has to be the availability and cost of trained skilled staff, because that is a huge issue in the sector. For the first time, a further element needs to be the number of people ageing without children—that is a phrase which covers a number of different circumstances. We have now got to the point where Secretaries of State for Health admit openly that we have a health and social care system predicated on the fact that the majority of care, and management of care, will be done by families. There are at least 1 million people who do not have children, and it is children we are talking about. We do not even record the number of men who do not have children; we do not have that basic data, and yet we are expecting them to manage care. Unless and until we do that, there will be a profound effect on those people when they come to moments of crisis, such as hospital discharge. We need the Government to start to really look at this issue.

The second recommendation is that we need, as a matter of urgency, the development of legislation, policy and protocols that governing the use of, and access to, data of health and social care users. Currently, we have a system in which the sharing of information just between the departments of an acute hospital is utterly random, and between the different parts of the health and social care system, between acute and community health, and social care and local authorities, is non-existent. We talk about care pathways, but they are rapidly becoming a fictional idea. I defy anybody—a professional, a user or a carer—to know what a care pathway is and how to get from one place to another. Unless and until we sort this, we will have an ineffective, expensive mess: duplication of services on the one hand and lack of access to basic services on the other.

My third point is that, as regulators of health and social care—particularly the CQC as it goes into the new single assessment framework—look at these new integrated care systems, they need to specify who is responsible not just for a single episode of care but for care pathways. We have not begun to see that yet, and it is fundamental to our ability to build a system which works in the long term.

I suspect, in the run-up to the election, there will be calls from some people to say that we ought to take care away from local authorities; that for the sake of efficiency, we either put everything under the NHS, or outsource much more to the voluntary sector, charities and faith groups because they will make better use of limited resources. I would caution against that. Local authorities have a public equality duty and access to population data, and to data about individuals within their areas. I think it is crucial that we stick with them.

Finally, as president of the National Association of Care Catering, I want to make a plug for meals on wheels: old-fashioned, much denigrated, but an absolute lifeline to people. I had the privilege of being an undercover meals-on-wheels volunteer a couple of years ago—I said I was a trainee; I do not think most of them would have given me the job. The immense value of low-tech services to older people cannot be overestimated. We really should make sure that those services which give great value are maintained for older people.

Adult Social Care

Baroness Barker Excerpts

Monday 20th February 2023 Lords Chamber

[Lord Markham (Con)]

It is lovely to have noble friends.

Given the conversations I am sure we will come to shortly about improving hospital flow and the 13% of beds that are blocked, we felt that the focus needed to be very much on providing beds for short-term care. That is where we wanted to put the £7.5 billion of extra funding. We thought that was the immediate priority because we knew the flow issues were impacting A&E, ambulance wait times and everything else. That is not to say that we do not intend to implement all the Dilnot reforms, but the priorities were very much around improving flow and discharge.

[Baroness Barker (LD)]

My Lords, when Sajid Javid was Minister for Health and Social Care, he stated publicly what some of us had long suspected: namely, that we have a health and social care system that is predicated on the assumption that people will be looked after primarily by their families. One million people are ageing without children; they do not have close family to look after them. When will his department acknowledge the existence of this group of people, and when will it be a requirement for planners of health and social care to take them into consideration?

[Lord Markham (Con)]

Again, I would like to say that the big increases in funding—the 20% increase that we are talking about in two years’ time—are very much an acknowledgement that there is a demographic issue here, where more and more people are going to be coming into this situation. That is why we are putting those plans in place and working on the workforce; we are already seeing thousands of people being recruited every month to assist with capacity in the system. So we are putting in place the plans to address that.

Maternity Services

Baroness Barker Excerpts

Thursday 9th February 2023 Lords Chamber

[Lord Markham (Con)]

I agree with the work by my noble friends, including the noble Baroness, Lady Cumberlege, to put the importance of midwifery continuity of care at the centre of everything. The survey to which my noble friend’s question refers shows that that is coming through in terms of a consistent message that having that confidence in the person in treating them is vital to all of this. That remains important. Key to this is the workforce, so this is one of the things that is being built into the workforce plan. That is starting with ensuring that we have new people coming in. The 1,200 graduates that we now have going into training each year are a vital part of making sure that we can deliver.

[Baroness Barker (LD)]

My Lords, report after report shows that the current system of treating maternity and reproductive health services on an episodic basis is costly and inefficient. Will the Government undertake to review that so that we can begin to go back to the system where staff were trained in both maternity and general nursing? We could therefore treat women on the basis of the whole of their lifestyle and get back to doing the most important jobs, such as making postpartum contraception available, which in the end would not only enable women to be treated more safely but save the NHS money.

[Lord Markham (Con)]

That question probably deserves a more detailed reply then I can give here in 30 seconds. In terms of the direction of travel, continuity of care, not just in the maternity service but in understanding that person and their needs, has to be the right thing to do to make sure that we have cradle-to-grave treatment with people who know your case. So I agree with that direction of travel and I will follow up with a more detailed response.

Mental Health Act Reform

Baroness Barker Excerpts

Thursday 26th January 2023 Lords Chamber

[Lord Markham (Con)]

Yes, I too saw the statistics on the number of black people who are detained. Clearly that is not right and is something that we need to get on top of. I know that the NHS has set up a patient and carer race equality framework to try to tackle this, but clearly we need to act on it. Again, it is the responsibility of every ICB to ensure to tackle this as well.

[Baroness Barker (LD)]

My Lords, a key reason why people with learning disabilities and autism are wrongly detained under the Mental Health Act is that mental health professionals are not trained to recognise autism and learning disabilities. Without waiting for legal reform, will the Government work with the professional bodies now to train and retrain psychiatrists and psychologists in learning disabilities and autism so that we can stop the scandal of these people being locked away wrongly for years and years?

[Lord Markham (Con)]

Yes, and understanding starts in schools. Again, I am very aware of that, and of the fact that training in schools is vital. We have increased the proportion of schools with trained mental health assessors from 25% last year; it will shortly be about 35%. The target is 50% next year. It is not 100%—we need to do more—but it is rapid progress.

NHS Dental Services

Baroness Barker Excerpts

Tuesday 24th May 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Lord makes an incredibly important point about how we must look at this holistically and not just try to solve one problem or plug one gap while ignoring others. The important thing is what NHS England is doing in conversations about the new contracts. It is looking at how we incentivise dentists to offer services in those areas which are so-called dental deserts. It is also looking at how all the roles have changed over the years. We have certainly seen primary medical care taking on more secondary care. We have also seen pharmacies and others taking on more, so we are looking at different roles around dentists and whether they can take on more of that.

[Baroness Barker (LD)]

My Lords, the Government announced £50 million in extra support for dental practices earlier this year. How many of the practices which received some of that money are in rural areas, which are particularly hit and facing a crisis where about 20% of their dentists are due to retire?

[Lord Kamall (Con)]

The noble Baroness highlights one of the issues that must be addressed: those areas, particularly low-population areas, but also coastal and some rural areas which are so-called dental deserts. It should also be noted that a person is not necessarily permanently registered with a dental practice. You only have to register for as long as your treatment lasts, and if you cannot get treatment at one practice, you should be able to try other practices. You can try 111. I have heard various reports. Some people have told me that 111 is incredibly effective, while others have told me that there are still dental deserts in their local area.

Health and Care Bill

Baroness Barker Excerpts

Consideration of Commons amendments
Tuesday 5th April 2022 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

I am grateful to the noble Baroness, Lady Eaton, for raising this issue. I should declare that some years ago when I was a GP, I was responsible for looking after three care homes with children with really quite profound psychological disturbance because of what they had gone through prior to being taken into care. I carefully read the briefing from the Royal College of Paediatrics and Child Health. It is very important to listen to that college in particular, which has put out a remarkably strong briefing that also takes account of children up to the age of 25 when they are care leavers.

The last time we debated this I was concerned about contraceptive advice. I therefore contacted an abortion provider to ask about the contraceptive advice provided and was assured that really sound contraceptive advice is part of the telemedicine procedure. Does the Minister have any data on the number of second-time and third-time abortions that are being requested through telemedicine, as compared with those from face-to-face consultation? Certainly, in my time in practice, when one provided contraceptive services, one always felt that when somebody was presenting for an abortion, somewhere along the line one’s contraceptive advice had failed—often because of coercion by the male partner, one way or another. But for those who are emotionally vulnerable it can be very important.

I will address in just one sentence the excellent speech by my noble friend Lord Crisp in relation to his Motion J1. I hope the Government will listen to it, because we cannot carry on allowing the tobacco industry to exploit public health in the way that we have.

[Baroness Barker (LD)]

My Lords, the noble Baroness, Lady Eaton, is a stalwart of these debates and she always takes a view that is contrary to mine. I say at the beginning of my speech that I do not question her integrity in any way at all, but I do question the briefing on which she has based her speech tonight—and I question the briefing from this particular college. It has a public position which says that young women should have the option and be

“actively encouraged to take up a face-to-face appointment”.

That is the policy now; there is no policy that says that people cannot and should not be allowed to have a face-to-face appointment if they need it.

Secondly, this amendment would require there to be a face-to-face appointment, whereas the position arrived at following the amendment moved by the noble Baroness, Lady Sugg, and in the Commons is that a teleconsultation can happen and that, at that point, if it becomes evident that there is a need for a face-to-face appointment, it must happen. As we explained when we debated this issue a few weeks ago, the greatest coercion is on women not to have an abortion rather than women being forced to have an abortion. Professionals, who took great care to design the telemedicine system at the start of the pandemic, made sure that they included safeguarding as an integral part of what they did.

The noble Baroness, Lady Eaton, is right in one respect and wrong in another. There was one case, within the first month of the scheme being set up, where a woman got her dates wrong. That was discovered and that case was used to change the questions and the training. I have to say that I take exception to her saying that there are dozens of cases, because in the peer-reviewed assessments that have been done in three countries, Scotland, England and Wales, that has not been seen to be the case. If anything, professionals have erred on the side of caution when they think that a woman might be approaching the deadline. I am afraid that in this respect I do not think the noble Baroness, Lady Eaton, is correct.

More to the point, throughout the discussions here and in another place, the professionals who have been responsible for not just delivering the services but for making sure that they are within ethical and professional frameworks and are monitored closely took into account all the ways in which they thought that young women and girls might be exploited. They took care to make sure that the services discovered that, and they have. They have found young women who have been trafficked. They have found young women who have been pressurised by partners. They have found young women who were prevented from going out to get contraception and therefore became pregnant.

I do not for one minute question the noble Baroness’s motivation, but I say to noble Lords that if they really want to protect young women and particularly girls, they should reject this amendment and accept the government amendment, which has been informed not just by the work of the noble Baroness, Lady Sugg, and others but by the majority of the royal colleges that practise in this field.

[Baroness Verma (Con)]

My Lords, I want to raise one thing that may be an unintended consequence of telemedicine abortion pills. In communities such as the one that I come from, having a girl is still seen as not a good sign of family life. I hope that when we discuss this, we discuss it in the round. There are communities in this country that may take advantage of the facts that women do not have to have a face-to-face and that women in those communities as often as not cannot communicate. We must ensure that we do not become complicit in them being forced into abortions. It is not about not wanting an abortion to be available if you require it. That is my point and my fear. I see it often in my community. It is not as if it is distant. It happens because those women and girls—some of them get married very early in life—do not have the ability to speak up, simply because of the confines of the communities they live in. I do not want it to be an unintended consequence that we end up being complicit in something that by and large is a choice issue but here may well become normalised within families where women and girls have very little say.