Mental Health Bill [HL]

Baroness Berridge Excerpts

2nd reading
Monday 25th November 2024 Lords Chamber

[Baroness Berridge (Con)]

My Lords, it was a privilege to sit on the Joint Committee to scrutinise the Bill, but it was disturbing to see for how long the legislation has been failing patients, their families and clinicians. I thank my noble friend Lady May, who is not in her place, for instituting the process and for placing a clear focus on the disproportionality faced by racialised communities. There is much to commend the Bill, such as the change in detention criteria, and statutory care and treatment plans, but it could still be improved.

The introduction of community treatment orders made a bad disproportionality situation even worse. The mental health factsheet accompanying the Bill says that black communities are seven times more likely to have a CTO than their white counterparts, although that is an improvement on the evidence to the committee, where we were told that it was up to 11 times, while Parliamentary Office of Science and Technology research states that it is up to 10 times. Whatever it is, it is too high. If CTOs are to remain, I hope the Minister will outline that proper research will be undertaken to understand what is causing that disproportionality.

While I welcome the changes to CTOs, I stand by the Joint Committee recommendation that they should be abolished for Part II patients; I stand with Mind on that. There are differing opinions on this issue now, and it would be useful to return to it in Committee. Because of disproportionality, the CTO issue is of particular importance to certain communities. However, I agree with the noble Lord, Lord Adebowale; we also heard about the informed research showing that advance choice documents are known to reduce detentions and reduce medicalisation when someone is detained. So, while I am pleased to see the advance choice document in the Bill, I ask His Majesty’s Government to consider that there should be a right to request that.

As the Bill goes through Parliament, I hope that the hard work of a smaller, often less-resourced group of activists for these communities will be appreciated. The work of the NAS and Mencap is exemplary, but sometimes those who are not able to shout the loudest are in the greatest need of our support. I am sad to notice that two of the provisions that are particularly important to racialised communities are being diluted.

One of the most important changes is that the outdated use of nearest relatives is being replaced by nominated persons who represent the patient and exercise relevant statutory functions. It is important to note the power that the nominated person has. It includes the power to order the discharge of the patient, unless of course a barring order is made. Ideally, the nominated person is chosen by the patient, but if they do not have capacity, that function is done by the approved mental health practitioner—AMHP. Those are welcome changes for most adults—I note the comments from the noble Lord, Lord Alderdice—but the Joint Committee’s report highlights that all is not clear with regard to the nominated person and children and young people.

The decision not to have a new piece of legislation is a particular problem. When the Mental Health Act 1983 was passed, it was envisaged that it would really apply only to children in the criminal justice system. To complicate matters, the Children Act 1989 was passed, with further amendments later on giving 16 and 17 year-olds the right to consent to medical treatment if they have capacity. Then came the Mental Capacity Act, which does not apply to under-16s but does if you are 17. Then Gillick competence was added to the mix. Yes, it is all rather fudgy, even before you add on the nominated person under the Act.

I will give a couple of examples. For the under-16s, under new Schedule A1, the nominated person must be the person with parental responsibility, but what of the situation of a special guardianship arrangement where the parents keep some residuary parental responsibility? Does the AMHP have to appoint the parents and the special guardian? That would set up quite a difficult arrangement for clinicians. Also, why does this schedule refer to a local authority being “willing” to act as the nominated person? Under the Children Act when there is a care order, local authorities have a duty to act when they have parental responsibility.

I turn to the 16 or 17 year-old who lacks capacity to appoint a nominated person. There is no mention at all of parents’ responsibility in paragraph 10 of that schedule, yet the young person might be living with them. So if the nominated person uses the powers of discharge, a process takes place for them to be discharged. You are relying on the mental health institution to remember that parental responsibility lasts until someone is 18 and to tell the parents that the patient is on their way home. That might not sound like a problem, but if you have got other, younger children in the household, it might be a risk to them to have that person back in the household. Also, a 16 or 17 year-old may be under a care order. Is the local authority going to be informed because it is going to be providing the accommodation? The schedule is silent on that. A common statutory mechanism is to mandate for particular circumstances like those of the under-16s but to have a presumption for other situations. So why not have some kind of presumption that a 17 year-old person with parental responsibility should be the nominated person if they are residing with them?

The previous Government accepted that after the independent review on children and young people more thought needed to be given. So will the Minister agree to have a meeting about children and young people with officials, interested Peers, and the experts in this field who are practising in this niche area of the Mental Health Act and the Children Act?

Children and young people are also in a vulnerable position if they have learning disabilities and autism and no co-occurring mental health illness. If they are in crisis and the parents need help, if there is no Mental Health Act provision, then what happens? We have heard about the use of DoLS under the Mental Capacity Act, but if you are 17 or 18 and lack capacity and are held under that, there is no Section 117 aftercare. However, if you are under 16, or 17 with capacity, you are not under the Act at all. Where does that leave you? That probably leaves you under the inherent jurisdiction of the High Court or, rarely, a care order. Only last week the Children’s Commissioner reported on around 1,000 children a year who are now under the jurisdiction of what is called a High Court DoLS order. Let us just say her report is not good news about that third provision to restrict a person’s liberty.

While the situation for those with learning disabilities and autism is currently shocking—and I marvel at the work of the noble Baroness, Lady Hollins—the Act could make a bad situation worse. This is also important to cover at the meeting that I have suggested and as High Court DoLS are a relatively new creation, it would be good to have there former members of the judiciary who have had experience of imposing those orders on children and young people.

I am disappointed not to see the recommendation from the Joint Committee of a mental health commissioner as part of the Bill. Since the Joint Committee reported, rare events have shown the danger to the public if mental health services fail. Often it is those who not medically trained but are friends and family who can see that someone is getting really unwell and needs help. Is it obvious to know where to go if you have tried the previous hospital and you have tried to use PALS? Do friends and relatives know that it is the CQC that they need to go to? The police have rightly stepped back in some respects in these situations. Not appointing a mental health commissioner is a missed opportunity as it is imperative that those people know somewhere to go to. While the Joint Committee’s report was not overt about this being a function of the mental health commissioner because it was before the events I have outlined, an emergency process such as this could well fit within their remit. It would be a one-stop shop. While there is a mental health homicide review under way, if there is the need to legislate, we could now be missing it. However, if His Majesty’s Government established a mental health commissioner whose functions could be by way of secondary legislation, the door to legislation remains open if that review suggests such measures.

Finally, I hope the Minister will inform your Lordships’ House that the Law Commission is being requested to look at whether, in England and Wales, we should be doing what the noble Lord, Lord Alderdice, recommended, and which is happening in Northern Ireland: the fusing of our mental capacity and mental health laws. This is a sticking plaster only on an area of law that badly needs a restart.

--- Later in debate ---

[Baroness Merron (Lab)]

My Lords, I put on record my gratitude to all Members of your Lordships’ House for contributing to what was widely agreed, I am sure, to have been an excellent debate—excellent not just because of the level of engagement but because of the detail. I really feel that spirit of wanting to improve the legislation and the support for the Bill thus far. I will endeavour to respond to as many themes as possible; I am very grateful to the noble Lord, Lord Kamall, for his sympathy, which I accept, but I regard that as a good thing. I regard it as admirable that I will not be able to answer all the questions, because that is the purpose of being here. It sets us up for Committee. It is obviously going to be a very rich Committee, and I very much look forward to it.

I hope noble Lords will understand that I look forward to following up on the many points that I will not get a chance to address in the time I have and doing a proper review of the debate today, picking up points as needed. I pay tribute to the dedication and the detailed attention to the Bill that noble Lords have already given. I am very glad to see my right honourable friend the Secretary of State gazing on. The reason I say that now is that the Secretary of State knows only too well—and not just from me—the contribution that your Lordships’ House makes and will continue to make. I for one certainly appreciate it, as I know he does.

I also thank the noble Baroness, Lady Parminter, for her bravery in sharing her and her family’s experience and anguish of eating disorder. I say the same to my noble friend who shared her experience about her sibling. It is not always easy to do that, but it really brings a lived experience of those around the person we are often thinking about, and it is so important that we do that. This debate has confirmed to me what I knew already—but it is always worth doing it again. It is the product of persistence and of a number of investigations and recommendations. It is also inspired and underwritten by the tireless campaigning that many have undertaken to improve the rights and experiences of people with mental health conditions and learning disabilities and autistic people.

It also reflects the input of those with lived experience, which was first raised as necessary in the debate by the noble Baroness, Lady May. It is about striking the right balance between getting the details of a framework of legislation right, along with the urgent need for reform, and the point that noble Lords have raised about how that is going to be done.

Attitudes and knowledge, as many noble Lords have acknowledged, have changed radically. Mental health is increasingly out of the shadows, and through the Bill we can make sure that legislation does a much better job of keeping up with a shift in societal attitudes and expectations and the development of treatment.

Regarding the role of your Lordships’ House, like the noble Baronesses, Lady May and Lady Barker, I recognise the relevance of this House. I too welcome that the Bill has started its passage through Parliament here because I believe your Lordships’ House will do the job that it is here to do, which is to improve legislation, and this debate today has certainly confirmed that.

In looking at what we are trying to achieve, I am reminded of the words of Professor Sir Simon Wessely in his foreword to the independent review’s final report, where he said that

“we want the Mental Health Act to work better for patients, the public and professionals. We hope that the result will be to reduce the use of coercion across the system, whilst giving service users more choice, more control and better care, even in the event that detention is still required. And we particularly hope that the end result will be to reduce the inequalities and discrimination that still remain”.

Almost six years after the former Prime Minister, the noble Baroness, Lady May, commissioned that independent review, the draft legislation before us speaks to those aspirations as well as delivering our manifesto commitment to modernise the 1983 Act.

On the reduction of detentions, I certainly agree with the noble Baroness, Lady Murphy, and other noble Lords that reducing detentions cannot be achieved by legislation alone. It will depend on having the right services in the community.

New models of care in the NHS are already giving over 400,000 adults greater choice and control over their care. We are also trialling new models of care through six early implementers, bringing together community crisis and in-patient functions into one neighbourhood team that will be available 24 hours a day, seven days a week, to increase access and improve continuity of care in the community. I know from the debate today that many noble Lords are looking for that sort of development and good practice.

As we know, the Bill makes a number of improvements in respect of patient experiences and care, and of the increase of choice and autonomy. It seeks to tackle racial discrimination and provide safety for public, staff and patients, and to provide better support for those with autism and learning disabilities.

I turn to some of the main themes that have been raised. I say to the noble Baroness, Lady Tyler, that we continue to be committed to engaging with those with lived experience. Part of the point of the Bill is that, where those with lived experience have not had their voices heard, I believe our continued engagement will allow that.

On racial inequalities, many have spoken passionately about this matter, including the noble Baronesses, Lady Watkins and Lady Buscombe, and the noble Lord, Lord Adebowale. The racial disparities associated with the operation of the current Act were one of the many drivers of reform, and rightly so. The changes in this Bill will give patients greater say in their treatment and encourage more collaboration and less coercion in care and treatment planning, which are all crucial to reducing inequalities. This will include increasing oversight and scrutiny of community treatment orders, where racial inequalities are at their most acute. It will also be about encouraging the uptake of advance choice documents, where those with lived experience, as I said in my opening remarks, have been very generous in their reference to their use in reducing inequalities. Legislating so that people can choose their own nominated person will also protect rights.

Inequalities in outcomes are not just a result of how the Act has been applied but also due to wider social and economic factors. We will therefore be working across government to ensure that the Bill’s provisions are effectively implemented, aiming to reduce those racial disparities in decision-making under the Act, starting with using the code of practice to make clear which actions can be taken in the application of the Act. We are also taking forward non-legislative reforms recommended by the independent review, including the Patient and Carer Race Equality Framework and also piloting culturally appropriate advocacy models to support those from minority ethnic backgrounds to understand their rights under the Mental Health Act and to give voice to their individual needs.

On the mental health commissioner, I have heard many comments, including those expressed by the noble Baronesses, Lady Murphy, Lady Barker, Lady Buscombe and Lady Berridge, and the noble Lord, Lord Bradley, and others. That is quite a group to address, but I will have a go. It is true that we have not taken forward the pre-legislative scrutiny committee’s recommendation to establish a statutory mental health commissioner. We recognise that improvements need to be made to the quality of care and the patient safety landscape. However, the concerns are that the proposed mental health commissioner’s function would be potentially largely duplicative of existing bodies and functions, and nobody wants to risk diluting accountability or causing confusion. As noble Lords will know, Dr Penny Dash has been asked by the Secretary of State to assess if the current range and combination of organisations within the healthcare regulation landscape is effective and to make recommendations of what might be needed, and I think it is important that we await her recommendations.

Learning disability and autism were raised by a number of noble Lords, in particular by the noble Baronesses, Lady Hollins, Lady Buscombe and Lady Browning, my noble friends Lady Keeley, Lady Ramsey and Lord Touhig, and the noble Lords, Lord Scriven and Lord Adebowale. This is a very important point and I recognise that we want to improve care and support for the over 2,000 people who are currently detained, as well as anybody who may need support in the future. We know from the NHS’s safe and wellbeing reviews that four in 10 people who are detained in this group have needs which could have been met in the community with appropriate support. That is why we are going to be focusing on developing community services and improving the quality of care, which will happen alongside the Bill’s reforms.

Through the Bill, we will be taking forward a package of measures for those with a learning disability and autistic people, so there will be a significant programme of work, alongside investment. I will be pleased to engage with expert stakeholders and those with lived experience, including parliamentarians, and to update your Lordships’ House as we progress.

With regard to the recommendations of the pre-legislative scrutiny committee, there is no doubt in my mind that the Bill has benefited greatly from undergoing scrutiny in 2022. It is a better Bill for that and we have tried to incorporate more of the Joint Committee’s recommendations within it. Many of those recommendations relate to the statutory code of practice and we will consider how we take these forward following Royal Assent.

On the important point of implementation, raised by many noble Lords, including the noble Lords, Lord Adebowale and Lord Bradley, the truth is that we estimate that the full implementation of these reforms will take around 10 years. The speed at which we can implement will be limited by the time that we need to expand and train the workforce. This goes to the point raised by the noble Lord, Lord Kamall, and I am grateful for his honesty in the way that he described previous work on the workforce. I thank him and his ministerial colleagues—predecessors of mine—who have worked on this.

The reality is that while some reforms can commence much sooner than others, we will need to commence powers under the new Bill in phases. Implementation will depend on what happens during the passage of the Bill and the reality of future funding settlements—to the point raised by the noble Lord, Lord Stevens—as well as other developments, such as the 10-year plan, but I can briefly give an indicative timeline.

A small number of reforms relating to the criminal justice elements of the Bill will commence within two months of Royal Assent. In the first year after Royal Assent, there will be a focus on updating the code of practice and creating the necessary secondary legislation to enable implementation. We will need a further year to train existing staff on the reforms and ensure that processes are in place. We would therefore hope to commence the first phase of significant reform in 2027, and to commence further reforms as and when there is sufficient resource in place to do so. In the spirit of honesty, the truth is that for what I would call the most burdensome reforms—for example, the increased frequency of mental health tribunals—those would not be likely to commence before 2031-32.

Alongside the passage of the Bill itself, we are looking closely at implementation in relation to learning disability and autism. Again, the exact timing of implementation of the reforms will depend on future funding. I know that noble Lords will understand that I am limited in what I can say on that, but we have already demonstrated our direction of travel by: treating and resourcing mental health seriously, including having a mental health professional in every school; introducing open-access Youth Futures hubs; recruiting 8,500 mental health workers; and having £26 million in capital investment. Indeed, there is the priority that many noble Lords, including the noble Lord, Lord Crisp, have acknowledged of bringing this Bill forward as a matter of urgency.

The noble Lord, Lord Meston, and the noble Baroness, Lady Berridge, raised the disparity of treatment between children and adults. It is true that there are a small number of reforms which do not apply to children and young people, as was also raised by the noble Baroness, Lady Watkins. It is the case that there is a difference; nevertheless, we are committed to improving children and young people’s autonomy over their care and treatment. We still believe that these reforms will go some way to achieving this. Like adults, under-18s should be supported to share their wishes and feelings by the clinician when it comes to care and treatment decisions.

On the issue of prison transfers, which was raised by the noble Baroness, Lady Watkins, and the noble Lords, Lord Scriven, Lord Bradley and Lord Adebowale, we recognise that operational improvements are needed to ensure the safe and effective implementation of the statutory 28-day limit. NHS England is indeed taking steps to address some of the barriers to timely transfer of patients. The wording in the Bill, which refers to the need to “seek to ensure” a transfer within 28 days, should be sufficiently robust to provide accountability for a breach of that time limit, while recognising that there are multiple agencies involved.

As we know, while this legislation—

[Baroness Berridge (Con)]

I hate to interrupt, given the lateness of the day and the lateness of the hour, but the point that a number of noble Lords were making in relation to children is that this Bill potentially does not sit with the principles under the Children Act. If the Government intend impliedly to repeal parts of the Children Act, then it would be good to have that clarification from the Dispatch Box.

[Baroness Merron (Lab)]

I look forward to coming to that point in Committee. The marrying up of legislation will be important, as is making progress on the Bill. That applies to the point of the noble Lord, Lord Alderdice, and others about fusion. We do not want to hold up this Bill while we make progress, but we will be mindful of the interface with other legislation.

In this Bill we are starting with the most overdue reforms to make the law fit for the 21st century. I very much look forward to working through the Bill in much greater detail in Committee. I am most grateful to all noble Lords who have not just spoken this evening but worked to get us to this point.

Support for Infants and Parents etc (Information) Bill [HL]

Baroness Berridge Excerpts

3rd reading
Friday 15th November 2024 Lords Chamber

Moved by

[Baroness Berridge]

That the Bill do now pass.

[Baroness Berridge (Con)]

My Lords, on behalf of my noble friend Lord Farmer, I pass on thanks to all noble Lords who contributed to the Bill and for the assistance of the House for making the passage of the Bill so efficient. I note that the Bill is based on the early years review from the Department for Health and Social Care, which indicates that, at such a stressful time, many parents could benefit from some form of legislation to ensure that they are aware of the help available to them from charitable and publicly funded sources. I beg to move.

[The Earl of Effingham (Con)]

My Lords, I thank all noble Lords who gave of their time and effort to make a valuable contribution to the Bill. In particular, I pay tribute to my noble friend Lord Farmer, whose efforts on the Bill, as well as on hospices, special needs schools, prison reform and many other areas, will pay dividends for future generations.

By providing parents with accessible and reliable updates on infant care, the Bill empowers families to make informed decisions, fostering stronger family units. This aligns with our principles of personal responsibility and informed choice, helping parents independently to support their child’s development. It equips parents with early-stage guidance to help address any issues at the onset, potentially reducing future reliance on public services, which will enhance efficient government spending, with early support minimising the need for costly interventions later in life.

By offering parents resources on key topics such as nutrition, health and time-tested milestones, the Bill promotes stable and forward-looking early childhood experiences. We value family stability as a cornerstone of society, and many on our Benches view this as a proactive step towards creating responsible, well-adjusted citizens.

Finally, by providing parents with essential information, the Bill aims to reduce unnecessary visits to healthcare outlets, enabling resources to be allocated to those with more urgent and complex needs. This aligns with His Majesty’s Official Opposition’s aims to relieve pressure on the NHS and optimise efforts on the long-term sustainability and success of public services.

Hospices: Funding

Baroness Berridge Excerpts

Thursday 24th October 2024 Lords Chamber

[Baroness Berridge (Con)]

My Lords, I thank my noble friend Lord Farmer for securing this debate and the noble Lord, Lord Monks, for sharing his story so well.

How many times do noble Lords hear guests of the Palace of Westminster being told that no one can die here as it is a royal palace; people always legally die across the river at St Thomas’ Hospital. However, if you live in, or in the vicinity of, the Palace of Westminster and need end-of-life care, you are more likely than not to receive it from my local hospice, Royal Trinity Hospice in Clapham. The NHS contributes only 25% to 30% of its funding per year, but over half the people needing end-of-life care in the catchment area of south-west and central London use Royal Trinity Hospice. What is clearly an NHS service should be properly funded by the taxpayer. Whether in the vicinity of a palace or in social housing in the most deprived area of the country, there should be a national minimum standard of provision, as outlined in the excellent APPG report on hospice funding.

I also agree that ICBs should be made to look at a multiyear contractual term, as I often wonder how much charitable time, energy and money are spent bidding for money from the ICB. We know that the demographics show that there will be an increase in demand for hospice care over the coming years, so the sector should be free to plan to deliver more, not to fill in more bidding forms.

I am sure that no one would want the hospice movement to be solely government funded, as vital flexibilities and community relationships are built due to the inclusion of the charitable model of funding, raising about £1 billion a year. In fact, this is the perfect time to have this debate, as we are days away from the Budget. Although it focuses mainly on tax and spend, it is also normally the place where changes are outlined to any of the benefits for charitable giving. Legacies are a large proportion of hospice charitable funding, including around £2 million a year for Royal Trinity Hospice in Clapham. Many of these people will already be payers of inheritance tax, and if you leave 10% or more of the net value of your estate to charity, you can reduce the rate you pay from 40% to 36%.

Why are there not the same benefits for other estates that are smaller and that do not pay inheritance tax, and for whom the gift is often a greater sacrifice? If the policy is to look at income, capital and wealth on a more equal level, why is there no gift aid on small legacies? Also, why do you get more tax allowance if you are a higher-rate taxpayer and claim gift aid, but no benefit if you are a standard-rate taxpayer? I know the Minister cannot give detailed answers to those questions, but I hope she will agree with this focus: that if there is more wealth to tax, surely, we should also incentivise people further to give that wealth away.

Vaginal Mesh Implants: Compensation

Baroness Berridge Excerpts

Thursday 5th September 2024 Lords Chamber

[Baroness Berridge (Con)]

My Lords, I too thank the noble Baroness for securing this debate and the panel for its review and tenacious follow-up of remaining recommendations, particularly recommendations 3 and 4 on financial compensation.

I am a member of your Lordships’ Select Committee on the Inquiries Act. With recent reports from statutory public inquiries on Grenfell and Covid-19, non-statutory inquiries such as this can be overlooked. While Grenfell and Covid-19 clearly needed the statutory model, it often comes with unhelpful TV images of banks of lawyers, looking like a courtroom. I do not want to pre-empt the publication of our report in the next few weeks, but it seems that both the noble Baroness and Bishop James Jones, who led the non-statutory Hillsborough review, managed to obtain the trust of victims’ groups, which is essential to that model. Along with my noble friend Lady Sugg, I too applaud those groups who were maturely able to see the advantages and merit of the non-statutory process and, I hope, found it less arduous than the courtroom-type hearings.

A number of recent inquiries—into the Post Office, Grenfell and infected blood—have led to the establishment of compensation schemes. Given the systemic failures outlined so clearly in this review and the avoidable harm caused, I would be grateful if the Minister could outline fully what distinguishes this request from those of the other schemes, if His Majesty’s Government’s position has changed since 4 July. Now that His Majesty’s Government are overseeing a number of these schemes, I hope there is co-ordination over the levels of compensation given, for instance over the costs of care in the home, so that there are comparable tariffs across the schemes. But the request for a redress agency, and the three separate schemes in advance of this, sits in a landscape of similar medical schemes—on variant CJD, vaccine damage and thalidomide, to name just a few. Why are these three schemes not just as worthy as those other medical schemes? I hope the Minister can justify this distinction.

In relation to vaginal mesh, will His Majesty’s Government not have had to consider how to justify on objective, reasonable grounds a decision that looks, prima facie, like indirect discrimination against women? I suspect that, more tellingly, the reason will be to do with the costs. As the review outlines, in other countries big pharmaceutical companies and the suppliers of devices contribute. Will the Minister undertake to meet these companies and ask them to bring a full assessment of the costs to them of litigation, both successful and unsuccessful? Could she also prepare a full assessment of the cost to the public purse of leaving this just to litigation?

By a full assessment I mean, inter alia, the legal costs and compensation paid out by NHS trusts in successful claims, the costs not recovered from the other side even in successful cases, the often unrecoverable lost time of medical staff having to attend court and prepare witness statements, and the costs of court time and of class actions being brought against the Secretary of State. Even if the HPT class action has been discontinued, what was the civil servant time, ministerial time, and Government Legal Department time involved in the case—and the cost to the public purse of debates and Questions in Parliament, including the private office time preparing the Minister and sitting in the Box? Could the companies and public purse assessments be compared to the costs of running a scheme similar to those I have outlined?

There are also non-financial costs borne by the victims and society. The awful testimonies of the debilitating effects of surgery are harrowing—I am so grateful that my loved ones have always had amazing NHS care. But perhaps there are women struggling with their disabilities who think, “If I had a bit extra to buy some help, I could get back to work, maybe just part-time”, or women who are managing their lives and thinking, “I could do some work, but now I have to take on litigation. That is really the final straw”.

The country needs as many people as possible in the workforce. Can the noble Baroness request any relevant information that the DWP holds in relation to these women? For instance, how many are in that situation? Would the noble Baroness be content for women who might be listening today to write to her to outline such situations—and, of course, add the civil servant cost of replying to that correspondence to the full assessment I outlined above?

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

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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

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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

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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.