Mental Health Patients: Discharge

Baroness Berridge Excerpts

Tuesday 5th March 2024 Lords Chamber

[Lord Markham (Con)]

Like many of us, I am sure, I have had very good personal experience of the midwifery service at community level. I know that there have been some challenges post Covid, but midwives are on the front line in understanding and recognising some issues. I should have mentioned earlier that there will be a round table with the Minister on mental health issues, following the one a few months ago, and this is one of the areas we should bring up with her.

[Baroness Berridge (Con)]

My Lords, as a member of the Joint Committee scrutinising the Bill, it was clear to me that one of the problems was that there is a statutory list of next of kin which does not match the reality of some people’s lives, so there were provisions to introduce a nominated person. It does not matter how good the guidance is. How are we circumventing the statutory requirement for next of kin to be involved?

[Lord Markham (Con)]

Again, like many noble Lords, I understand the disappointment that there has not been the time for the mental health Bill. This is what the round tables are about: exploring with Maria Caulfield, the Mental Health Minister, how we can ensure that we implement as many of these things as possible. We had round 1 and we will set up round 2 shortly. I suggest we take it up then.

Dementia

Baroness Berridge Excerpts

Thursday 18th January 2024 Grand Committee

[Baroness Berridge (Con)]

My Lords, I am grateful to my noble friend for tabling this debate. As well as having family experience, I also served on the Joint Committee on the Draft Mental Health Bill.

Lack of parity has created complex administrative processes for practitioners, patients and families. It is clear to me, from having two elderly relatives needing support, that you risk not getting the best outcome if you do not understand the system and are not able to advocate for them. With the first relative, we had the baptism of fire of continuing healthcare assessments. Putting aside the obvious distress to the patient and relatives caused by these meetings, there is also the time off work and lost income. The typical cast at these meetings would be the nurse, manager and staff of the nursing home, the discharge team from the hospital, social workers, patient and relatives. Meetings last one to two hours, plus travel time for the professionals, of course, as they have to take place in the nursing home. They may also need to be repeated or paused as the patient may be in and out of lucidity or competence.

The amount of resource gobbled up by these meetings was remarkable, and we had three attempts at it. Often the agenda seemed not to be about nursing care requirements, just whose pot of money it would be coming from—it is all taxpayers’ money, of course. Can my noble friend the Minister outline what assessment has been made by the Government of how much the process of continuing healthcare assessments is costing the NHS? If there was the parity outlined by my noble friend Lady Browning, this resource could of course be saved.

By the second relative, we were no longer newbies but, in that case, we bumped into the Mental Health Act. Some forms of dementia include mental health symptoms, such as delusions or hallucinations. My relative, who had such symptoms but had not yet been diagnosed with dementia, consented to going into a secure mental health hospital. I was quite affronted when a friend who commissions local authority services said to me, “Shame they consented and weren’t detained under the Mental Health Act”. Later, when I was on the draft Bill committee, I knew what he meant: Section 117, on aftercare. Although not automatic, it includes accommodation and can include all your care, hence the Times newspaper headline back in 2014: “The ‘secret’ law that means dementia care can be free”. It is not means-tested and you do not have any more continuing healthcare assessment meetings.

Can my noble friend the Minister outline whether there is data on how many people with dementia are detained under the Mental Health Act without any pre-existing history of disease? Also, is he aware of the anecdotal reports of clinicians now feeling under pressure to detain people when relatives know that it will not alter the care but could save them tens or hundreds of thousands of pounds? Are we at risk of this coming to be seen like the EHCP situation, where relatives know that the Mental Health Act will lead not only to the best care but to the taxpayer funding it? More importantly, is this adding to the pressure on NHS mental health beds?

Nothing that I have said detracts from the amazing care staff, who were often as bemused as we were by this not so wonderful world of administration and bureaucracy. Surely there must be a better, kinder and more efficient system.

Mental Health Act 1983

Baroness Berridge Excerpts

Tuesday 21st November 2023 Lords Chamber

[Baroness Berridge (Con)]

My Lords, the committee heard about disproportionality, particularly with community treatment orders, which are about 11 times more likely to be imposed on someone from an ethnic-minority background. Can my noble friend the Minister look at that, and maybe meet with colleagues in other departments to see whether there is a legislative opportunity to sort that out by putting that provision into a different piece of legislation?

[Lord Markham (Con)]

Yes. I have tried to get into this further, and my understanding is that lot of the trouble is that there is often a fear from black and ethnic-minority people of the existing institutions that can help people early on. As we all know, with mental health difficulties, we have to act quickly. A lot of this is about getting everyone in society open to the idea that the earlier they can go to these sorts of places, instead of trying to brave their way through, the better. That is one of the key things to do to make sure that we do not then see problems down the pipeline, including the disparity whereby a black person is 11 times more likely to have community reviews and the disparity in detentions.

Mental Health In-patient Services: Improving Safety

Baroness Berridge Excerpts

Monday 3rd July 2023 Lords Chamber

[Lord Markham (Con)]

I understand the concern brought, quite rightly, by the noble Lord. It would be best for me to write on that, so that I can give the specific position and he can have the detail he requires.

[Baroness Berridge (Con)]

My Lords, I am a member of the Joint Committee. We heard compelling evidence from the Independent Advisory Panel on Deaths in Custody that, although there is always an inquest into an unexplained death, there is the unique situation where if you die detained, in effect, by the state but in a secure mental health institution—as opposed to a prison, police cell or immigration detention centre—there is no independent investigative body to investigate the circumstances around your death. Given that this independent inquiry will look at a series of deaths over 20 years, will it be within its remit to look at whether or not, had there been some kind of independent investigation of those deaths, the themes and problems faced by the trust might have been spotted earlier?

[Lord Markham (Con)]

We see that as being very much in the remit of the Health Services Safety Investigations Body. In fact, the first thing we are asking it to do is to consider how we can learn from those unfortunate deaths, where they have taken place, in terms of their care. The intention is that it will report back. It will start in October and will report back on that within a year, so that we can get some rapid findings.

Childbirth: Black Women

Baroness Berridge Excerpts

Wednesday 3rd May 2023 Lords Chamber

[Lord Markham (Con)]

The noble Lord is correct that data is an issue. A lot of the frustration that Minister Caulfield expressed is about the fact that we are having to look in the rear-view mirror, because the data is about two years old. One of the fundamental things is to get that live data so that we can see what action works and where more needs to be done.

[Baroness Berridge (Con)]

My Lords, it is also sad to note that the rate of black babies being stillborn is 6.9 per 1,000 births, as opposed to 3.6 per 1,000 for white babies. Can my noble friend the Minister please confirm that each trust is under an obligation to collect that kind of data and do specific research as to why a modern country has that really sad rate of higher mortality?

[Lord Markham (Con)]

That is what the equity and equality plans are all about: understanding the local needs of an area. As I mentioned before, a lot of this is often due to the underlying health conditions of that ethnic-minority group. Also, many of us take for granted the fact that we are very clear on how to access medical services, but a lot of people from these ethnic minorities do not have the experience—for want of a better word —of accessing them. A key part of the plan also needs to be about how we can make this care accessible for all these groups.

Mental Health Act Reform

Baroness Berridge Excerpts

Thursday 26th January 2023 Lords Chamber

[Lord Markham (Con)]

I have some personal experience in this space, so I understand exactly what the noble Lord is saying. I think we all agree on its importance. We have a commitment to decrease the number of in-patients with learning disabilities and autism by 50%. It is something that every ICB must have a lead on, so that they can really tackle it, and I personally would be happy to meet the people the noble Lord mentioned to understand further.

[Baroness Berridge (Con)]

My Lords, this process began four years ago, with the then Prime Minister announcing the initial reason for the review, which was the disproportionate way that the Mental Health Act is applied to many black and minority ethnic communities. Beyond the review and the White Paper, the Joint Committee recommends the abolition of community treatment orders, which are disproportionately applied: if you are black you are 11 times more likely to be under a community treatment order. Most of the recommendations of the Wessely review were to be enacted by changes within NHS England. Can my noble friend the Minister assure us that he will hold its feet to the fire to change the culture, practices and training of many of our mental health professionals, because those communities are being disproportionately affected by the way the Act operates?

[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.

Times Health Commission

Baroness Berridge Excerpts

Thursday 19th January 2023 Lords Chamber

[Lord Markham (Con)]

Clearly, the patient has to be at the centre of everything. That is what the plan for patients is about. It is also what patient choice is about; we are using other ways to make sure that people can get treatment quickly when they need to. It involves using the independent sector, as pioneered by colleagues in this House, and learning lessons from that so that we can get on top of waiting lists, which we all agree we need to do.

[Baroness Berridge (Con)]

My Lords, on the day when the Joint Committee on the draft Mental Health Bill has published its report, can my noble friend the Minister assure us that, while we hear a lot of talk about health, when the ideas are in the department, mental health and the situation in secure units are taken into account—we have the same problems of delay and discharge in those units—so that mental health is given the parity with physical health it deserves?

[Lord Markham (Con)]

Yes. Unfortunately, one of the results of Covid was our understanding a lot more about the cases of mental health caused by it. We have put more investment into that as a result; it will be key to this issue as well.

Hospital Beds: Social Care

Baroness Berridge Excerpts

Monday 19th December 2022 Lords Chamber

[Lord Markham (Con)]

It absolutely is a high priority. Noble Lords have heard me say many times that the key to the whole system is flow through the system, to relieve times in A&E and ambulance wait times. That flow depends on us discharging the 13% of beds that are currently held up. That is why we put the £500 million discharge fund in place and will put £2.8 billion of funding next year, and £4.7 billion the year after, to solve exactly this problem.

[Baroness Berridge (Con)]

My Lords, I currently serve on the Joint Committee that is scrutinising the mental health Bill. Could my noble friend the Minister outline whether that 13,000 includes those who are perhaps in secure mental health beds, awaiting discharge? That of course causes backlogs, and not only into A&E: currently, some of those people could be being held in a police cell, which is not an ideal place if you need admission for assessment to a mental health bed.

[Lord Markham (Con)]

I will happily write on the detail, but, yes, it includes everyone who could be provided a space, either in a care home or a mental health home, and those who are fit to go home but need domiciliary care.

Abuse and Deaths in Secure Mental Health Units

Baroness Berridge Excerpts

Wednesday 9th November 2022 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend for the work that she and others are doing in this space. I agree that we need to respond rapidly. As I said, this is very high on Minister Caulfield’s agenda, and I assure my noble friend that we will be looking to respond quickly.

[Baroness Berridge (Con)]

My Lords, I am also serving on the Joint Committee mentioned by my noble friend. We received evidence that the highest rate of mortality for those held in custody between 2016 and 2019 was among those held under the Mental Health Act. If you die in a prison or an immigration centre, there will be an independent investigation under the Prisons and Probation Ombudsman, and if you die in police custody, the IOPC will investigate. There is no independent investigation should you die while detained under the Mental Health Act. Is that not a lacuna that the Government could look into in relation to deaths while being detained under the Mental Health Act?

[Lord Markham (Con)]

My noble friend raises a good point. My understanding is that the rapid review that we seek to put in place would involve an independent chair, because independence is key in this area. On the detail of whether that should be the case for every death, I will take back that point and respond to my noble friend.

Queen’s Speech

Baroness Berridge Excerpts

Tuesday 22nd October 2019 Lords Chamber

[Lord Bassam of Brighton (Lab)]

My Lords, given that the Queen’s Speech was little more than a poorly disguised election gimmick, it is surprising that there were no new proposals for legislation or policy on education, never mind higher education. To recap: the Government have failed to respond to the Augar review, published in May 2019, or to bring forward their own proposals for a sustainable model for HE funding. The Conservative-led coalition Government trebled tuition fees, overseeing a system in which the average student now graduates £50,000-plus in debt, while students from the most disadvantaged backgrounds graduate with an average debt of some £57,000. The system urgently needs to be reformed. Labour has committed to scrapping university tuition fees so that education is genuinely free for all and students do not face the prospect of a lifetime of student debt simply for seeking a decent education.

On HE funding, this is all the Government have to say:

“We are committed to making sure that higher education funding reflects a sustainable model that supports high quality provision, maintaining our world-leading reputation for higher education and delivering value for money for both students and the taxpayer”.


In a nod to parental concerns about what good value looks like, they added:

“We want to ensure we deliver better value for students in post-18 education, have more options that offer the right education for each individual, and provide the best access for disadvantaged young people”.


As part of a search for the safety of the long grass, they added finally:

“We are undertaking a review of post-18 education to ensure we have a joined-up education system that is accessible to all”.


Who can argue with much of that? However, it is clear that the current funding system is not working for students, nor for those in FE and HE providers.

Meanwhile, universities are struggling to manage the impact of successive real-term cuts in their budgets. In the face of wage inflation and increasing pension contributions, not only does this have an impact on teaching, vital services and staffing, as costs outpace income, but it also makes forward investment planning more difficult, storing up problems for future generations and for students themselves. The system urgently needs to be reformed, yet the Queen’s Speech made no reference to the Augar review—no doubt in fear of raising expectations that cannot be met, as I said.

At the time, the previous Education Secretary promised that the Government would,

“come forward with the conclusion of the review at the end of the year, at the spending review. That has always been the plan”.—[Official Report, Commons, 4/6/19; col. 58.]

In the absence of the Government’s response to the Augar review, will the Minister set out a timetable for bringing forward proposals? Surely we have waited long enough. Universities need us to end the uncertainty, not least because our universities have to compete for students in a global market to ensure funding.

On widening participation, the Government say that they want to,

“provide the best access for disadvantaged young people”.

However, their decision to abolish grants worth £3,500 and replace them with additional loans that will have to be repaid was a mistake—a mistake that has left some of the poorest students saddled with a lifetime of debt. The Queen’s Speech was an ideal opportunity for the Government to announce the reinstatement of grants and a policy that would have been warmly welcomed across the House. It is therefore disappointing to see such a glaring omission at a time when income disparities are rising and are at their widest ever. In visiting universities over the past few months, I have been impressed by the steps that many of them are taking to change their demographic and widen participation. Birmingham is a particularly good example, with its dedicated support to students from hard-to-reach communities. Why are the Government not making this happen as standard?

Immigration policy is also an area of concern for the higher education sector, given that universities are dependent on overseas students for financial support and because of the tie-ups on international research projects. The Government’s Queen’s Speech pledged to introduce,

“a more accessible visa system to attract global scientific and research talent”.

This rings a bit hollow. It is worth reminding ourselves that 12% of the world’s international students attend UK universities and, as other Peers have noted, four of the top 10 global universities are here in the UK. We welcome the Government’s policy on work-study visas offering international students a two-year visa after graduation, up from the absurd situation they inherited under Theresa May. Can the Minister advise us of when the new system will come into play? Will it apply to entrants starting in 2020 or for students who are currently here, and how has this change been promoted? Given that the restrictions on post-study work visas was blamed for a drop in international student enrolments, communicating the U-turn will be key to reversing this trend by ensuring that prospective overseas students see the UK as a possibility.

On research and development, the Government said that they would be setting out plans in the autumn to significantly raise and boost public R&D funding. The statement has attracted support, but the other statement on introducing a US-style advanced research projects agency has alarmed the research community as it seems to miss the key point about research in UK universities. We need stability and certainty, something which at present is sadly missing. According to the Royal Society, since 2015 funding for Horizon 2020 has fallen by 28%, or €0.5 billion, and UK applications have dropped by a third. It is understandable that leading researchers do not want to gamble with their careers when they have no sense of whether the UK will be willing and able to maintain its global scientific leadership.

Through the Queen’s Speech, the Government announced plans to create a UK equivalent of the US Defense Advanced Research Projects Agency and to cut down on research funding bureaucracy. Over the past two years, UK scientists have already witnessed a huge reshaping of the funding landscape with the formation of UKRI. With this in mind, how will such a new body complement the work of UKRI? Moreover, does the Minister share our concerns and those raised by academics that the research and innovation communities—

[Baroness Berridge (Con)]

My Lords, the noble Lord has spoken for more than six minutes.

[Lord Bassam of Brighton]

I am conscious of that and I am coming to a close. Does the Minister share our concerns and those raised by academics about the creation of a new and different process running alongside the current one?

Finally, we have uncertainties about the future of research funding in the universities that help to drive the innovation that is vital to our economy. This fictional Queen’s Speech is a missed opportunity to answer hard questions—questions that will not go away.