Mental Health Bill [HL]

Baroness Bennett of Manor Castle Excerpts

Committee stage
Tuesday 14th January 2025 Lords Chamber

Moved by

[Baroness Bennett of Manor Castle]

4: Leave out Clause 3 and insert the following new Clause—
“Application of the Mental Health Act 1983: autism and learning disability(1) Section 1 of the Mental Health Act 1983 (application of Act: “mental disorder”) is amended as follows.(2) Omit subsection (2A).(3) Omit subsection (4).(4) At end, insert—“(4A) Mental disorder does not include autism or learning disability for the purposes of this Act.””

[Baroness Bennett of Manor Castle (GP)]

My Lords, in moving Amendment 4, I will speak to the Schedule 1 stand part notice, which is consequent on Amendment 4. Both appear in my name. I will not speak to the other amendments in this group, although my understanding is that Amendments 5 and 38 to 41 inclusive—tabled, variously, in the names of the noble Baronesses, Lady Browning and Lady Hollins, and the noble Lord, Lord Scriven—are effectively trying to achieve the same thing but by different means. I will leave them to speak to their amendments, because I want to explain why I have structured mine in this way.

I must begin by thanking Jen Smith at the Bill office for her great patience and expert assistance to this non-lawyer in producing this and a number of other amendments. I also want to stress that I am not, unlike many people taking part in this debate, an expert in this area, but I seek to represent voices of people who have reached out to me who may not otherwise be heard in your Lordships’ Committee.

I will set out the background to Amendment 4. I had a detailed briefing from the group Liberation, a user experience group led by people who have experience of mental distress and trauma, which has the slogan “for full human rights”. It is seeking a complete end to involuntary detention in psychiatric hospitals and forced treatment for the people it represents—people given mental health diagnoses. It asked me to exclude all people from what is known as detention or sectioning.

Liberation says that involuntary detention and forced treatment are forms of disability-based discrimination, and these people should not be subject to them. This may not be the case under the European Convention on Human Rights—I acknowledge that the noble Baroness, Lady Merron, signed a statement to that effect in the Bill—but I understand that it can be argued to be the case under the UN Convention on the Rights of Persons with Disabilities. I note, however, that the Parliamentary Assembly of the Council of Europe has, in line with Articles 12 to 14 of the UN CRPD, strongly endorsed a complete end to involuntary hospitalisation and compulsory treatment and recommended the removal of Article 5.1(e) from the ECHR—the paragraph that limits right to liberty if people are judged to be “of unsound mind”. It describes it as

“not compatible with our 21st-century understanding of human rights”.

I note that the recent report on the situation in the UK from the UN Committee on the Rights of Persons with Disabilities, particularly paragraphs 79 and 80, expresses concern about the lack of government measures to end disability-based detention and that the then Conservative draft mental health Bill continued to allow involuntary detention and forced treatment. The Bill brought before us by the Labour Government still has the same kind of provisions. The argument is that the Bill as it stands remains non-compliant with the UN CRPD deinstitutionalisation guidelines and the World Health Organization publication Mental Health, Human Rights and Legislation: Guidance and Practice, in which countries are urged to replace institutions with high-quality services.

I can almost feel your Lordships’ Committee saying, “How can that be possible?” Starting from now, that looks like such a long way away. That was indeed the question that I put to Liberation, which presented me with a number of case studies from around the world. I imagine that the Minister is aware of the case of Trieste, in north-eastern Italy, which almost managed to abolish involuntary detentions. They have been replaced with wide-ranging and accessible community services, based on a whole-person approach. Its community mental health centres are open 24 hours a day, seven days a week, and they play a key role in preventing people reaching a point of crisis. This has enabled people with mental health diagnoses to remain in and be part of their local community, in line with Article 19 of the UN convention. Compulsory psychiatric treatment orders are still possible, but the numbers are very low and orders typically last seven to 10 days.

In Spain, Act 8/2021 recognises the legal capacity of all adults and stipulates that disabled people should receive the same legal treatment as non-disabled people, including those with mental health diagnoses and learning disabilities. This is still not complete equality but it is heading that way and has made further progress than we have.

Costa Rica, Peru and Colombia have all taken steps in this direction. In Peru, for example, a recent study on the impacts of crisis interventions indicates that involuntary detention rates have been significantly reduced and that, when people are detained, they typically leave hospital after a couple of days.

In Mexico, the general health law of 2022, a national civil procedure code, says that everybody has legal capacity, including people with mental health diagnoses. It enables access to supported decision-making for everybody. Mexico City, in particular, has set a real lead in delivering on this, but I acknowledge that not all of Mexico has.

Why have I tabled an amendment that would, in effect, end detention for those with autism and learning difficulties? I feel like I must apologise to the people I have spoken to, as I did not feel able to put down another amendment—this a probing amendment, by nature—as I looked at the realistic situation. The noble Baroness, Lady Tyler, in starting our debate, referred to the extreme lack of resources. I and many others have amendments later in the Bill referring to the need for it to specify the level of resources. I am sorry that I did not feel able, even in this probing stage of Committee, to table another amendment. I would like to, and I would very much welcome the Minister’s comments on how we sit in that UN framework and whether the Government have a long-term goal to reach the kind of levels that an increasing number of other countries have attained, as I have just set out in my quick survey.

But I have to look at the reality of the statistics. I have looked at the figures in the briefing from the Royal College of Psychiatrists. The number of recorded detentions in 2023-24 is 52,500. We really have to reflect on that number. Of those, we have seen a fall, to 1,880, in the level of detentions relating to learning disability and autism—that seems a step in the right direction. We are talking about disabilities. Can we really continue, a quarter of the way into the 21st century, to detain people for their disability rather than provide them with the support they need in the community? That is a question this amendment seeks to raise.

I want to reflect on the fact—we will come back to this again and again—that people are not getting the help they need, and that is leading to the state of crisis we have now. I note in Mind’s briefing that people are crying out for help and not getting it. In June 2024, very urgent referrals to crisis teams for adults were 45% higher than a year before. I should here declare my position as a vice-president of the Local Government Association and refer to the LGA briefing, which talks about the significant resource implications for councils of the Bill as it stands as presented by the Government.

There are voices here that should be heard. We should frame this in the context of the international situation of the UN Convention on the Rights of Persons with Disabilities. That is why I have tabled this amendment. I hope we can have a constructive discussion and see some real progress here today. I beg to move.

[Baroness Browning (Con)]

My Lords, I declare my interest as a vice-president of the National Autistic Society and a co-chair of the APPG on Autism, and I have responsibilities for close relatives who are on the autism spectrum.

I will speak to Amendment 5 first, and to the Mental Capacity Act, which is not the Act we are looking to change but it is my contention in this proposed clause that the Mental Capacity Act has a relationship with the Mental Health Act.

There has for some years been concern about the deprivation of liberty safeguards as defined in the Mental Capacity Act 2005. They were inserted into the Mental Health Act 2007 following the Bournewood judgment in the European court which involved an autistic man whose liberty was denied, whose carers were ignored, and who had had what I can best describe as an autistic meltdown that resulted in his incarceration for a very long time.

Although the Mental Capacity Act has much to commend it, there has been ongoing concern about the deprivation of liberty safeguards—often referred to as DoLS—and I managed to obtain a House of Lords inquiry into the Act in 2013, ably chaired by the noble and learned Lord, Lord Hardie, who is in his place today. I will quote a section of the summary of that inquiry that deals specifically with deprivation of liberty safeguards. The House concluded:

“The provisions are poorly drafted, overly complex and bear no relationship to the language and ethos of the Mental Capacity Act. The safeguards are not well understood and are poorly implemented. Evidence suggested that thousands, if not tens of thousands, of individuals are being deprived of their liberty without the protection of the law, and therefore without the safeguards which Parliament intended. Worse still, far from being used to protect individuals and their rights, they are sometimes used to oppress individuals, and to force upon them decisions made by others without reference to the wishes and feelings of the person concerned”.

--- Later in debate ---

[Baroness Merron (Lab)]

There is no need to apologise.

I am pleased to provide the reassurance that the proposed changes to the Section 3 detention criteria mean that it would no longer be possible to detain someone with a learning disability or an autistic person under Section 3, unless they have a psychiatric disorder. Additionally, the Act already requires a statement of rationale for detention and statutory forms. The registered medical practitioner will have to confirm that the patient meets the criteria for detention, including that they are suffering from a psychiatric disorder requiring hospital treatment and not just that the patient has a learning disability or is autistic. I hope that will be of reassurance to the noble Baroness.

For the reasons I have set out in respect of all the amendments—I thank noble Lords for them—I ask the noble Baroness to withdraw hers.

[Baroness Bennett of Manor Castle (GP)]

I thank the Minister for her rich and full response, and indeed all noble Lords who have taken part in this important debate. It has been long but that has been quite necessary. I thank the Minister particularly for responding directly to my question about the UN Convention on the Rights of Persons with Disabilities. I do not agree with her response but I appreciate that she engaged fully with it, so I thank her for that.

I will not go through and summarise all the contributions, but I just want to make two points, which are perhaps specifically directed to the noble Lord, Lord Kamall, and the noble Baroness, Lady Murphy. A phrase which has been missing from our whole debate is the “social model of disability”. That is the idea that society is discriminatory, and that people are disabled by the barriers in society, not by their difference. That position was endorsed by the Government Equalities Office in 2014, and so far as I know, that still holds, and it is preferred by most disability charities.

I invite noble Lords to consider another phrase in this healthcare space, which is “parity of esteem”. I think that when we come to the social model of disability and physical disabilities, most people have now accepted that if there are only steps and not a ramp, that is a failure of society, not the failure of the person in the wheelchair. However, we have not heard in this debate an acknowledgement of the same parity of esteem—the same approach to mental disability as we have accepted towards physical disability—and we should consider and think about that.

In that context, just to pick up a couple of points from the Minister, she talked about how people with autism or learning difficulties can be detained for aggressive or irresponsible conduct. The Trieste model—if I can call it that—which is being adopted by many countries around the world, asks: “Can we intervene before that point and ask what has provoked that person? Can we intervene before we need to detain someone?” That needs to be very carefully considered.

The other point that the Minister addressed, which I confronted myself with, asking why I did not table the broader amendment that I might have done, is what happens when people get to the point of being a danger to themselves or—I stress that this is extraordinarily rare—a danger to others as a result of a mental disorder. Again, how did people get to that point, and should there not be services and support and community wraparound in the Trieste style? I do not think that any nation or area is saying that it has totally got to that point, but surely we should be aiming at that.

[Lord Kamall (Con)]

The noble Baroness referred to the Trieste model, and I thought that led to quite a deal of interest from noble Lords across the House. Could she share some details on the Trieste model with other noble Lords but especially the Minister and the department, so we can all start learning those lessons?

[Baroness Bennett of Manor Castle (GP)]

I should absolutely stress at this point that I am not an expert, but I will certainly do my best to secure as much information as possible and share it with all noble Lords. The Minister may also have access to resources that may not be available to me. Reflecting on the intervention of the noble Lord, Lord Kamall, perhaps we could even arrange some kind of discussion—it might be useful—and perhaps even hear some testimony, because that would really inform our consideration of the Bill. But in the meantime, I beg leave to withdraw the amendment.

Amendment 4 withdrawn.

--- Later in debate ---

[Baroness Butler-Sloss (CB)]

My Lords, I should like to speak to Amendment 9, following on from the noble Lord, Lord Scriven, on Amendment 8.

We are dealing with the responsible commissioner making arrangements for the care (education) and treatment review meetings and the report. I do not know whether I am a lone voice speaking in this House but I am a mother and a grandmother, and there is not a single word in any part of this Bill about parents or guardians—not a word. I could find references to parental responsibility only in new Schedule A1 and Schedule 2, although I may be wrong.

Can I just suggest something to noble Lords? Where you have a child—here, I am dealing specifically with a child—with autism or physical or mental disabilities, it is quite probable, if not most likely, that that person will be living with their family and their parents. I must say, my experience as a family judge led me to believe that only about 5% to 10% of parents who came through the courts were not suitable to look after their children full time. But according to Clause 4—which inserts new Section 125A—the one group of people who will not be told what the future care (education) and treatment review given to their child will be includes the people with whom that child has been living for all their life. I cannot understand why this Bill seems to think that parents, guardians and other people with parental responsibility do not matter. That is why I have raised this issue. I feel intensely strongly about it, as a mother and a grandmother.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I shall speak very briefly, having attached my name to Amendments 19 and 20. I support all of the previous amendments, which are in essence about people knowing about care and treatment review plans. I particularly wanted to sign these two amendments because of the clause identified by the noble Lord, Lord Scriven, and the noble Baroness, Lady Hollins. It states that integrated care boards and local authorities “must have regard to” the plan—as the noble Lord outlined, that is a very weak, weaselly form of words—rather than having a duty to deliver the plan that has been established for the well-being and health of a person. The phrase in the Bill now really is not adequate.

I want to share something with noble Lords. On Friday night, I was in Chorley, in Greater Manchester, at a meeting with the local Green Party and NHS campaigners. One of the things I heard there was a huge amount of distrust and concern about integrated care boards and the restructuring arrangements that have happened with the NHS. I am not going to get into those issues now but, with the words “must have regard to”, we are leaving an open door and a door to distrust. Surely the right thing is for this Bill to say that the ICB has a duty to deliver a care plan.

On Amendment 20, we will undoubtedly talk endlessly about resources, but that there must be a compelling reason is the right terminology to have in the Bill; it really has to be justified. I believe that both of these amendments should be in the Bill.

[Baroness Tyler of Enfield (LD)]

My Lords, I will speak to Amendment 13 in my name in this group, but wish to add my support to the amendments that have already been talked about: those in the names of my noble friends Lady Barker and Lord Scriven, and the very important amendment in the name of the noble and learned Baroness, Lady Butler-Sloss. I have experience in my wider family of someone with autism, so I know full well the importance of having the parents and the wider family involved in review meetings. Frankly, it would be very difficult indeed if they were not there for those review meetings to express the wishes and preferences of the individual concerned.

I guess that that is quite a helpful link to my amendment, which is about communication needs. I know that we explored this issue pretty thoroughly in our debate on the first group—you could argue that my amendment could have been in either the first grouping or this grouping, but it is in this grouping. I will keep it short, because we have talked about this quite a lot. In essence, the amendment is designed to ensure that communication needs being met is included on the list of the subject matter that must be considered and on which recommendations must be made during the care (education) and treatment review meetings.

It is clearly vital, as we have all acknowledged, that every effort is made to ensure that autistic people and people with learning disabilities are involved in their own care and treatment decisions and are able—this is the critical point—to express their preferences and needs. To ensure that this is the case, their communication needs must be understood, considered and met; the noble Lord, Lord Kamall, made that point powerfully in our debate on the first group. Often, this needs to include understanding a person’s communications preferences; having the right sort of environment; making sure that the environment is supportive; or, sometimes, using very specific communication tools, which do exist. This can also include—this refers to the amendments from the noble and learned Baroness, Lady Butler-Sloss—the involvement of a person who knows and understands the patient well, quite often a family member or advocate. That can be key to meeting someone’s communications needs.

I am sure we all agree that care and treatment reviews need to be designed to ensure that the person affected is central to the decisions being made about their care and treatment. It is therefore absolutely self-evident that communications needs should be considered and discussed at the beginning of those meeting to ensure that the person concerned is able to express their thoughts, wishes, feelings and preferences, so that everyone involved in the care and treatment of individuals is equipped to meet those moving forward.

I am very supportive of the amendment tabled by my noble friend Lord Scriven which would lengthen the time between reviews from 12 months to six months. I think 12 months is just too long. An awful lot can happen in that period and circumstances can change. I know that we have a subsequent group on care and treatment plans, but on the point made by my noble friend Lady Barker, it is important to think of the individual in a fully joined-up way, looking at housing needs as well. I know that we are going to return to it in a subsequent group, but it vitally needs to include things such as money matters, debt advice, ensuring that the individual does not fall into financial exclusion and all of that. I have put my name to an amendment on that in a later group.

Puberty-suppressing Hormones

Baroness Bennett of Manor Castle Excerpts

Monday 16th December 2024 Lords Chamber

[Baroness Merron (Lab)]

My noble friend is right to raise the second point. It is a whole range of interventions, and that is certainly something that we have very much in mind for consideration, for the reasons that we have heard in the Chamber this evening and the points that my noble friend makes. In respect of timings, it is a planned pathway study and that includes a clinical trial component. It is, as I said, to build evidence. I am glad to say that it remains on track to commence recruitment early in 2025, but only after there has been ethical approval. When that is granted, that is when the final study protocol will be ready, and I know that noble Lords will have a lot of interest in that. We will be issuing further updates in early 2025, and if there are any particular questions, noble Lords are very welcome to raise them with me.

[Baroness Bennett of Manor Castle (GP)]

My Lords, my question follows on from that of the noble Baroness, Lady Walmsley, about the scale of the trial. I also note the report from the experts at the Council of Europe, which the noble Baroness referenced. In the other place, the Secretary of State said in response to my honourable friend Carla Denyer that the clinical trial would be “uncapped”, and the Minister repeated that word this evening. However, an article published yesterday in the Metro, arising from various freedom of information requests and headlined, “Trans Youth ‘Languishing’ While Waiting Six Years For Gender Healthcare”, said:

“If a trans young person joined the waiting list for gender-affirming healthcare on the NHS today, they would have to wait 308 weeks for a first appointment”.


In that context, I am struggling to understand where the Government will secure the resources from to run a trial to provide the resources needed to have this uncapped clinical trial allowing access to puberty blockers.

[Baroness Merron (Lab)]

In view of what the noble Baroness said, it is quite important to consider that the children and young people’s gender services waiting list currently has 6,237 people on it. I certainly agree that waiting lists for these services are too long. We are committed to changing that, which is why I outlined the timetable for the new gender services and the opening of the new centres. They will increase clinical capacity and reduce waiting times for sure. On the point the noble Baroness raised, there is a commitment to the clinical trial, and I am glad there is. As we have brought forward this legislation in an absence of evidence, it is incumbent on us, as a Government, to follow through on what the previous Government started in train, which is to use a clinical trial to provide the evidence. Otherwise, the debate would remain uninformed and not evidence-based, and that cannot be helpful.

Physician and Anaesthetist Associate Roles: Review

Baroness Bennett of Manor Castle Excerpts

Thursday 5th December 2024 Lords Chamber

Asked by

[Baroness Bennett of Manor Castle]

To ask His Majesty’s Government what the review, announced by the Secretary of State for Health and Social Care on 20 November, of the physician associate and anaesthetist associate roles will cover; and what actions they plan to take in advance of the outcome.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I thank noble Lords for staying with us late on a Thursday for this debate. I know there are many noble Lords, among them the noble Baronesses, Lady Finlay and Lady Brinton, who moved regret Motions about the statutory instrument passed under the previous Government that is behind the mess we are discussing today and who would have very much liked to take part.

I will not go over the same ground as I did in February, when I begged the then Government to pause their action, but the concerns expressed then have only grown, reflecting many of the reasons why Professor Gillian Leng has been asked to conduct the review of PA and AA roles. In the words of consultant Partha Kar, the Government’s national adviser on diabetes, we have seen

“months of heated debates, social media uproar, royal colleges in turmoil, and the reputation of many national organisations being questioned”.

Professor Kar has described this as

“the worst example of a policy implementation in the NHS I’ve seen”.

I note that just this week the Irish Medical Council concluded that it was not the appropriate body to regulate PAs, and referred to

“the potential for emerging patient safety risks arising … as observed recently because of regulation of PAs by the GMC in the UK”.

I shall ask a large number of questions. To be fair to the Minister, and to ensure that this debate is as constructive as possible, I have shared my questions with her in advance. I begin with the first part of my question, about the review itself. I have heard only respect and hopeful feelings about Professor Leng being appointed as lead, but many concerns have been expressed to me about the level of co-operation that the review will receive and the quality of information available to it. Just yesterday, the GMC wrote to medical bodies, nine days before it is due to begin registering PAs and AAs, saying that it would

“soon publish a report on the outcome of the consultation and the research; along with the final drafts of the rules, standards, and guidance”.

That report was published just two hours ago, before this debate started.

Does the Minister consider that to be an appropriate timetable and level of transparency? Is the Minister happy with the response of the GMC to requests for information over this difficult year? Can the Minister assure me that Professor Leng will have the necessary resources and that the Government will do everything necessary to ensure that she receives full co-operation and transparency?

We have seen many different, often disturbing, localised reports about the ways in which PAs in both hospital settings and general practice have been deployed. Knowledge and concern about the deployment of PAs and AAs is growing among patients and the general population. I note that the Fire Brigades Union conference in May voted to oppose the growing use of PAs. Will Professor Leng have the resources to access those public views?

The review’s remit seems quite narrow. An obvious omission is the ask from the Royal College of Physicians that it should consider the impact of the PA role on training opportunities for resident doctors. Will the review do that? Further, will it consider the fundamental issue that the “taskification” of medicine is a massive change from previous practice and a reversal of the recent growing understanding of the need to consider the whole human, and their environment, in supporting health and tackling disease?

Our debate in February heard considerable concerns about the impact of PAs on doctors’ training. There were suggestions from all sides of the House that a major revamp of training arrangements for doctors needs to be put in place. Can the Minister write to me about what plans the Government might have in that area? I want mostly to focus what interim measures the Government plan to deal with what is clearly an untenable current situation. In February, the then Minister, the noble Lord, Lord Markham, said that PAs and AAs are

“very much a supplemental role rather than a substitute”.—[Official Report, 26/2/24; col. 912.]

Of course, that is not what has been happening, as demonstrated by a letter sent in March from NHS England to ICBs and trusts. It said that PAs

“should not be used as replacements for doctors”

on rotas, yet a detailed investigation by “Channel 4 News” in October found widespread subsequent use of such substitutions. A number of trusts indicated that they did not even keep any records of such substitutions. Does the Minister stand by that NHS England guidance? What will the Government do to ensure that it is implemented?

The Government’s announcement of the review said that it is to report in spring 2025. Your Lordships’ House knows that government definitions of seasons means that that could extend well into the year. By the time report is absorbed and action decided, realistically, we are talking about a year of a clearly untenable situation. Does the Minister agree that interim action is surely needed?

In September, the governing council of the Royal College of General Practitioners voted to oppose a role for physician associates working in general practice. Reports suggest that, as a result, PAs are being made redundant—they have my sympathy—and general practices face the risk of legal action. How will the Government deal with this situation and prevent it escalating, at great cost to NHS services?

The council of the Royal College of Physicians has agreed that there is a limited role for physician associates working in secondary care in the medical specialties, as long as they are supported by clear supervision arrangements, professional regulation and a nationally agreed scope of practice. Do the Government agree? Will they take action immediately to deliver this, at least in an interim way? Do they agree that such supervision urgently needs to be defined?

I turn to caring for our children, and highly vulnerable patients at risk of rapid deterioration in condition, an area of particular concern. The Royal College of Paediatrics and Child Health has called for an immediate pause in the recruitment of PAs. Given the very disturbing situation that arose at Alder Hey hospital, does the Minister agree that there should be such a pause?

The House may well ask where guidelines across disciplines for national scope—a ceiling of practice—for PAs and AAs might come from. I was at the launch of a detailed, carefully prepared British Medical Association outline of a PA/AA scope document. I did not hear anyone express serious concerns about the activities of PAs and AAs being safe, if they were working to that outline. Does the Minister agree?

Later this month—very soon, I think—it is expected that the Royal College of Physicians will publish draft “safe and effective practice” guidance on the supervision of PAs, alongside a definition of the PA role drafted by the RCP resident doctor committee and agreed by both the PA oversight group and the RCP council. Does the Minister agree that this should be applied?

To back to our debate in February, I suggest that the Minister misspoke in saying that the GMC is regulating. What is due to come into practice on 13 December is a registration process for which there is a two-year lead-in period, so it will in effect remain voluntary until December 2026. I respectfully suggest that, without a national scope and clear guidelines for supervision, this cannot in any way be described as “regulation”. It is purely registration. Does the Minister agree?

I turn to AAs specifically, and an issue of grave concern—including legal concern—that was recently raised with me. In the current regulations, AAs and PAs are not allowed to prescribe or order ionising radiation. How can someone acting as an anaesthetist not do so? Expert advice that I have received suggests that the tool of patient-specific directive, which are meant to allow a doctor to direct another professional in making a limited choice of drugs under very specific circumstances, is being used and possibly misused. I am told that PSDs are being used to provide an extensive list of drugs for AAs to choose from; in essence, that means that they are prescribing. Can the Minister comment on that?

Finally, I turn to a couple of broader “What now?” questions. The NHS careers website’s PA/AA page, which I consulted yesterday, lists 39 universities offering courses for these roles. I have heard that several are pausing these courses. Does the Minister think it is fair to encourage students to start new PA and AA courses, given the uncertainty while the review is conducted?

I conclude by stressing that my questions to the Minister, my concerns and the mess that we are in now are not the fault of PAs and AAs who, in good faith, have signed up for service, studied and got the debt to show for it. Can the Minister assure me that the Government are committed to ensuring that a way forward will be found for them, whatever the review’s conclusions and future steps?

Mental Health Bill [HL]

Baroness Bennett of Manor Castle Excerpts

2nd reading
Monday 25th November 2024 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, as the last Back-Bench speaker in this rich and informed debate, I note that we in the Green group start our meeting each week by asking ourselves what original things we have to say, specifically as Greens, about a Bill or a debate—so it is useful to come at this particular point in the circle. As Greens, we very much agree with the need for the Bill, which virtually every noble Lord noted. We also very much agree with the need to strengthen it.

I respectfully disagree, however, with a number of noble Lords who have suggested that we are seeing an overmedicalisation of life events. Perhaps this is not quite what they meant to suggest, but it sounded like they were saying that we do not have a mental health crisis in our society. I would very much say that we do. I agree with the noble Lord, Lord Crisp, that there is a great need for more talking therapies and that, for want of those, medical professionals are very often forced to resort to pharma solutions.

We need the talking therapies, but we also need treatments because we have a mental health crisis. Behind that is not any characteristic of individuals but a deeply unhealthy society and, when we are thinking about this Bill, we have to think about it in that context. We have to think that when we compare ourselves to the societies we generally consider comparable, we have much greater health problems than them. We must ask ourselves why. This is true of mental and physical health, in so far as it makes any sense to make a division between those two. I do not think anyone this evening has yet used the phrase “the gut-brain axis”, but in the last decade there has been an explosion of understanding of the link between the microbiome and mental health. We have, particularly in the UK, a broken food system. This is of course a long way from legislation but, if we are to think systemically, it is the context in which we have to think about the Bill.

As some noble Lords have made reference to, there are also the social issues to consider, whether the levels of poverty, the insecurity of income and housing, or the pressurised jobs that treat workers like robots and make them ill. We have a loneliness epidemic, which I do not think anyone has mentioned yet, but that is very much related to our mental health epidemic. We have a huge problem with domestic violence, which is also related to mental ill-health, particularly among the victims. We need to take a public health approach to mental health. While that is not directly part of the Bill, we cannot talk about mental health without talking about all those issues.

On other areas on the Greens’ unique approach to mental health issues, we do not believe that the coercive power of the state—which is what the Bill is talking about—should ever be put into private hands; nor do we believe that healthcare should ever be run on a for-profit basis. Here, I remind us of the points made by the noble Baroness, Lady Keeley, about when the private provision of mental health care has gone horribly wrong.

A number of noble Lords have focused on the problem of stigma; perhaps we have made progress over recent decades, but we still have a long way to go. We have to think very carefully about using the rhetoric of “strivers versus skivers”, and the suggestion that all we have to do is get these people into a job and then they will be fine, because that is the underlying message we are hearing from certain very senior quarters in our society. I must mention that there has been talk of combining support for people seeking jobs and mental health care. I would not necessarily say not to do that, but it has to be done with extreme caution to ensure that it is not something that puts more pressure and stress on people, interfering with them becoming well.

More positively, I commend the Government on bringing the Bill forward so early in their term and on making it a Bill that starts in the House of Lords. I compare it to the Domestic Abuse Act, during the passage of which many noble Lords who have taken part in today’s debate also took part. There was a genuine effort from all sides of the House to make that Act better, and it has been very clear this evening that there is the same desire in this Chamber today.

Many noble Lords have made the point about the need to resource what is in the Bill—we also said that about the Domestic Abuse Bill—including, to single out a few, the noble Lords, Lord Alderdice and Lord Adebowale, and many others. There have also been some really good ideas in this debate, and here I particularly single out the noble Baroness, Lady Watkins. The idea of a safe staffing level for community services strikes me as a potentially transformative idea that is really essential. Far too often, care in the community has simply meant being abandoned in the community, being left in the hands of horribly overworked staff, who are then subject to abuse and questioning when things go wrong because they simply have not been able to handle the workload, through no fault of their own. It is really crucial that we tackle those issues.

I will quickly whizz through some specific points of the Bill, particularly focusing on things that other people have not said. I have not heard a great deal of discussion of the idea, as recommended by the Joint Committee on the Draft Mental Health Bill, that we have a mental health commissioner. The briefing from the Centre for Mental Health draws a parallel with the powerful impact of the Children’s Commissioner; I would also add the impact of the Patient Safety Commissioner, on which I worked with the noble Baroness, Lady Cumberlege, over many years. Again, that was a case in which your Lordships’ House was very powerful in pushing to create that position. Having the Patient Safety Commissioner has made a real difference, and having a new statutory role to champion mental health across government and speak up for people with mental illness is something we really should be including in the Bill.

Very briefly, I agree with the noble Baroness, Lady Fox, on community treatment orders. The Bill still allows these to be continued indefinitely rather than placing a time limit on them with an option for a new one if needed. These should not be renewed without proof of necessity and proportionality.

I will use my remaining time to focus particularly on the importance of children and young people. Many other noble Lords have addressed and given us statistics on how our mental health services are failing young people. I want to draw another parallel with another element of what the Government are doing and which I have praised. A couple of nights ago, rather late in your Lordships’ House—about this sort of time, actually—we were discussing the Government’s plan for a new youth strategy and their plan to make sure that there is really strong consultation on it with young people. The one direct question I will put to the Minister is: I am sure the noble Baroness is aware of the phrase “Nothing about us without us”. What is being done to ensure that there is a real say for young people, particularly young people with experience of the mental health system, to ensure they actually have the chance to be involved in the Bill?

I will rush into one final, technical point. The Bill introduces the new statutory care and treatment plans for all patients. That is welcome, but many under-18s are admitted on an informal basis, so they will not be covered by this. How will that be dealt with?

One final rushed point is that the noble Lord, Lord Alderdice, and others, have talked about how we can learn from other parts of the UK. The mental health Act in Wales includes a measure to give people the right to have a mental health assessment if they request help. That is surely something we could learn from and include in the Bill.

Government Policy on Health

Baroness Bennett of Manor Castle Excerpts

Tuesday 10th September 2024 Lords Chamber

[Baroness Merron (Lab)]

I thank the noble Baroness for sharing her experience of consulting widely. It is certainly entirely legitimate for government departments to do just that. However, those who do not have a formal role are not required to declare interests; it is different for those who have a formal role. Requiring them to do so would mean, for example, us sending forms in advance to Cancer Research UK before it comes in to talk to us about cancer and to assist us. Would we want that? We would not. Of course, where there is a formal role, we absolutely do that.

It is probably worth saying that a particularly high-profile invitation went from the Secretary of State to the noble Lord, Lord Darzi. He will report shortly on the true state of the National Health Service. He does not have a specific role in the department but he has been invited by the Secretary of State to assist; I believe that he will assist both your Lordships’ House and the other place.

[Baroness Bennett of Manor Castle (GP)]

My Lords, when the Green Party consults on health policy, among the organisations it consults are the Socialist Health Association, Keep Our NHS Public and 999 Call for the NHS—all organisations that are greatly concerned about the continuing privatisation of the NHS. Can the Minister tell me whether the Secretary of State or she herself have had meetings with any of those three organisations since coming into government?

[Baroness Merron (Lab)]

I cannot answer that, I am afraid. I would be very happy to look at it for the noble Baroness.

Vaginal Mesh Implants: Compensation

Baroness Bennett of Manor Castle Excerpts

Thursday 5th September 2024 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, I join what I am sure will be a chorus of praise for the noble Baroness, Lady Cumberlege, both for securing this debate and for her brilliant work over many years on these issues, particularly that of vaginal mesh. I started working with the noble Baroness during the passage of the Medicines and Medical Devices Act. If we think back, many of the things the noble Baroness was pushing for have since been achieved. However, today we are addressing some of the things that still desperately need to be dealt with.

One of the noble Baroness’s achievements was the appointment of a Patient Safety Commissioner. Dr Henrietta Hughes is doing a brilliant job and, as has already been referred to, brought out a report in February urging that the compensation schemes for both sodium valproate and vaginal mesh be brought in as soon as possible. I will just do a little bit of advertising for Dr Hughes. She still has a consultation open on the principles of better patient safety and there is one more day for a chance to respond to that, if anyone would like to do so. It is such important work that it deserves to be highlighted.

I want to put this in the broader context of where we are now. We seem to be hearing weekly about a cascade of official and government failures: the Grenfell Tower tragedy, the Horizon scandal, the infected blood disaster and the Hillsborough tragedy. Obviously, we have a new Government and they do not bear direct responsibility for any of those circumstances, but it presents them with an enormous challenge: the challenge to respond sensitively, appropriately and at sufficient speed to do everything possible to ameliorate the circumstances of the victims.

These cases also throw up the challenge of acknowledging that the talk about “cutting red tape” that we have been hearing for so many years is a deeply dangerous approach. We need rules, regulations and controls to keep us safe. As the noble Baroness, Lady Sugg, drew attention to, we need to keep under control what those who make profits are doing to increase them.

We also need to listen to the people who are adversely affected when things start to go wrong. The reality is that so often—we know this is particularly the case with female patients—for years and years people said, “There’s a problem here”, and officialdom said, “No, nothing to see here; it’s all fine”, sometimes even saying that it was all in their head. The Government really need to stamp on that tendency.

I understand that it is early days for the new Government, but I have noticed—this is not directed at the Minister in particular, but at the Government more generally—that when I put down Written Questions and get the Answers, I seem to get essentially the same Answers as I got a few months ago under the previous Government. I urge Ministers, both individually and collectively, to please be curious and challenging. If an Answer was given six or 12 months, or two years, ago, ask if it is still the right one, if indeed it was the right one in the first place.

I have some specific points. A number of people referred to the recent settlement in the court case against the manufacturers. One of the issues that raised was the fact that hundreds of women were unable to make a claim due to a strict 10-year time limit from the date that the product was manufactured. Are the Government planning to do something about that?

I join the noble Baroness, Lady Sugg, in paying great tribute to Sling The Mesh and other similar campaigners. Is the Minister ensuring that her door is open not only to that group but to many other campaigning groups? It would be great to hear that that is the case.

A further point is that Dr Hughes recommended at least an interim payment scheme for vaginal mesh and sodium valproate. The question everyone is asking is, when are we going to hear about that?

The Independent reports that June Dunne, a 64 year-old, has been waiting for corrective surgery since 2019. What are the waiting lists now like?

Finally, the official government figures say that there are 127,000 mesh implants. The campaigners say there may have been many more. Are the Government looking into making sure that they have the proper records of all people affected?

Vaping Products: Usage by Children

Baroness Bennett of Manor Castle Excerpts

Monday 2nd September 2024 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is a pleasure to follow the noble Baroness, Lady Walmsley, and to thank the noble Lord, Lord Storey, for securing this very important debate and reminding me that I should declare my position as a vice-president of the Local Government Association.

Seeing this on the Order Paper took me back to a moment when I really saw how much of an issue vaping is becoming. I was on a local train in the West Midlands when a young woman, maybe 18, was chatting on her phone to her friend. I remember the vehemence of the sentence that she stated then, talking about vaping: “You just need it so desperately; it’s much worse than cigarettes”. That point of addiction in the way that vaping is experienced by young people was driven home to me by that individual circumstance. This is a significant health issue.

It is worth looking at the fact that behind this is a semi-success story. The indoor smoking ban that came in in 2007, fairly strong labelling laws, education, and provision of cessation help have had a big impact. However, as the noble Lord, Lord Bethell, says, we seem to have hit a brick wall in making progress.

What has happened, as happens so often when regulating big business, is that an escape clause was levered out: vaping. It has become a new method of keeping big tobacco in business. All bar one of the giant tobacco companies have made substantial investments, as outlined by the Tobacco Tactics project of the University of Bath. I must ask the Minister a question here: are the Government concerned about the potential lobbying impacts of big tobacco on the operations of Government and Parliament? Do they intend to act on that level of influence, which is a threat to future action?

The noble Lord, Lord Winston, accurately said that there is a huge amount of uncertainty and that future research is needed. I was looking at a 2022 state-of-the-art review from the British Medical Journal, by Andrea Jonas, titled the “Impact of Vaping on Respiratory Health”. A sentence in it really struck me:

“The public health consequences of widespread vaping remain to be seen”.


We need to apply a precautionary principle, as was said by the noble Baroness, Lady Walmsley. Young people, who still have underdeveloped lungs, are taking who knows what substances into their lungs—certainly the Government do not know; no one really knows. Basic common sense says that this will certainly not be good.

It is worth looking at the figures. I am relying on the extensive briefing from the British Medical Association, which I am sure most noble Lords have received: 7.6% of 11 to 17 year-olds are vaping regularly or occasionally. That compares to 1.3% 10 years ago, so this really deserves the term “epidemic”. The YouGov survey quoted in the very useful Library briefing shows that 18% of 11 to 17 year-olds have tried vaping. That is nearly 1 million children. This is not a fringe concern.

As other noble Lords have said, many children are buying these products from shops illegally. This is very clear. It is also clear that many products are sold that do not meet health regulations. It is worth looking at the context in which this operates. I note a recent interview with the chief executive of the Chartered Trading Standards Institute, in which he pointed out that trading standards are not protected in local government budgets in the way that adult social care and children’s services are. Those two elements make up 80% of the budgets of many local councils. Trading standards are just one of the many essentials that have been squeezed and squeezed again.

This is a really useful case study in taking on the rhetoric that we hear all too often about how terrible red tape is. Protecting our children from dangerous substances and making sure that the law is enforced in shops is what some would call red tape, but I say that they need to be properly funded and supported. Among the many briefings that we have received is one from the Association of Convenience Stores stressing the cost of fully enforcing vape legislation. I was not entirely clear about where it was coming from, but it makes the point that, if we are going to do anything about this, we cannot just pass laws; we also need to fund their enforcement.

I noted in the King’s Speech in July that a tobacco and vapes Bill would be reintroduced. Can the Minister indicate whether that will include the promise of enforcement for whatever that Bill contains?

I pick up the point made by the noble Lord, Lord Bethell, about the need to future-proof that Bill. We are already seeing, in expectation of restrictions and controls coming in particularly on single-use vapes, that companies are adapting. We are seeing reusable replacements for these disposable single-use vapes already on the market, carrying the same brand name and looking very similar in product design. It is very hard to tell the difference between the single-use and the reusable. This is one of the ways in which people are attempting to intervene before the restrictions come in.

Another area that we need to look at very closely is nicotine pouches. Usage in the UK is relatively low compared to some other countries, but people in the social media world tell me that this area is exploding. We need to look at what restrictions might be placed on those products and how we stop creating an open door to be driven through.

As a Green, I feel that I must finally pick up a point made in the introduction by the noble Lord, Lord Storey, about environmental impacts, particularly of single-use vapes. We are talking about children’s health, but plastic in the environment is significant to the health of all of us, particularly children. I point to a recent study; I urge noble Lords to look it up if they have not seen it. A study of a sample of human brains found that they consisted of 0.5% plastic. Microplastics are everywhere: they are in testes, placentas, breast milk and brains.

Think about the world in which our young people live. In the UK, 1.3 million of these battery-powered devices, usually plastic, are discarded every week. Some 10 tonnes of lithium are thrown into the environment, which is sufficient to manufacture 1,200 electric car batteries a year. As with so many issues, this is a public health issue, an individual health issue and an environmental health issue. We need to look holistically at many of these issues from that one-health frame.

Coronavirus: UK Deaths

Baroness Bennett of Manor Castle Excerpts

Monday 29th July 2024 Lords Chamber

[Lord Lilley (Con)]

My Lords—

[Baroness Bennett of Manor Castle (GP)]

My Lords—

[Lord Kennedy of Southwark (Lab Co-op)]

My Lords, we have not heard from the Green Benches yet.

[Baroness Bennett of Manor Castle (GP)]

I thank noble Lords. Following on from the question from the noble Earl, Lord Clancarty, about long Covid, and of course continuing new cases are arising even from apparently initially mild infections, we also face the threat that I hope the Government are watching closely of H5N1 in terms of other respiratory diseases, and we know it is only a matter of time before another respiratory pandemic faces us. What steps are the Government taking to look at air filtration and ventilation systems to provide a better public health system that is more resistant to future diseases in schools and other public buildings and perhaps to provide ways for people to assess in premises they visit how good the ventilation and filtration is for them to be able to go into those environments?

[Baroness Merron (Lab)]

The noble Baroness offers some helpful suggestions as to areas that we can be looking at, but this for me all comes under the headline of resilience and certainly we are monitoring potential emergencies, including the one that the noble Baroness refers to. I can assure her also that preparedness will not just focus on respiratory means of passing on disease but will now look at all of the five routes of transmission, and I feel that will make us a much more resilient country.

Cass Review

Baroness Bennett of Manor Castle Excerpts

Wednesday 17th April 2024 Lords Chamber

[Lord Markham (Con)]

To take the second point first—it was also made by the noble Baroness opposite—that is absolutely right; it can be a real danger. People with English as a second language might not understand that a “person with ovaries” refers to them. It needs to be very clear. It is fundamental that the first description has to be “male” or “female”; you can then put additional parentheses after that.

The noble Baroness’s first point is exactly right. Until young people are through the age of puberty and its effects, they are not in a real position to make up their own minds. That does not mean that they should not be supported during that process, but it does mean that we should not be doing anything irreversible.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I watched the Secretary of State’s introduction to this Statement on Monday, live from my office. She asked the other place to

“bear the sensitivities of this debate in mind”.—[Official Report, Commons, 15/4/24; col. 55.]

I am afraid that it is clear from the printed record before us, and was even clearer watching the Secretary of State speaking, that it was delivered in a triumphalist, dogmatic tone, which meant that she did not follow her own prescription.

The Statement speaks of “myths” but fails to acknowledge the agency and lived experience of children and young people. I have two questions for the Minister. Can he reassure me that we are not going to lose, in this ideological debate, the need for massively more investment in services for children and young people in the NHS? The noble Baroness, Lady Burt, referred to the huge waiting lists that are behind the report we are discussing today.

The Statement also did not mention—and I think we have to acknowledge this—that hate crime against transgender people hit a record high in figures out last October. I hope that the Minister will agree with me that children and young people seeking gender identity services should not have to live in a society where their experiences are used as a political football. They should not be treated as a weapon in the culture war. They should not have to live in a hostile society.

[Lord Markham (Con)]

First, I think I speak for the whole House in agreeing that no one, under any circumstances, should feel that they live in a hostile society —whatever case it is, whether it is transgender, race, sex or whatever. I totally agree with the noble Baroness there. I will absolutely clarify this in the follow-up in writing, but I know that, in this specific area, the NHS has already committed £18 million in this space. Of course, this is quite separate from the £2.3 billion that I mentioned before in the mental health space generally, which, from memory—and I will absolutely clarify this—is the provision of 350,000 extra places for young people, because we know how much the demand is out there.

Sodium Valproate and Pelvic Mesh

Baroness Bennett of Manor Castle Excerpts

Monday 25th March 2024 Lords Chamber

[Lord Markham (Con)]

That is precisely what I put to Minister Caulfield this morning. She commissioned the review because her feeling was that the period from when my noble friend’s initial report came in until when Maria Caulfield was in post was too long. So it was absolutely she who commissioned it last year, and it is absolutely she who very much said that she is determined that there should be a substantive reply from us in the next few months.

[Baroness Bennett of Manor Castle (GP)]

My Lords, at the launch of the Patient Safety Commissioner’s report the victims of the Primodos scandal expressed great distress as they felt that they had been airbrushed out. Of course, the noble Baroness, Lady Cumberlege, recommended that they should receive redress, and they were treated the same way in the report as the sodium valproate and vaginal mesh victims. Can the Minister tell me what will be done to provide redress and ensure that there is appropriate treatment for the victims of Primodos?

[Lord Markham (Con)]

Again, these are difficult areas. My understanding is that we are working from the conclusions of the expert working group in 2017, and its review of all the evidence was that it could not find a causal link between Primodos and the impact it had during pregnancy. This was again reviewed by the MHRA when more information was brought up in the last year. So I am afraid that, as we stand today, the evidence is not there that suggests that causal link.