Mental Health Bill [HL]

Debate between Baroness Browning and Lord Kamall

Report stage
Wednesday 2nd April 2025 Lords Chamber

[Baroness Browning (Con)]

I am very grateful for that response. The noble Baroness said that autism is different; it certainly is different, which is why it has its own Act of Parliament.

[Lord Kamall (Con)]

My Lords, as I said on the previous group, I will start by speaking to the amendment in my name and that of my noble friend Lord Howe. It would require the Secretary of State to conduct a review into the ability of the CQC to effectively fulfil its role

“in carrying out its duties under the Mental Health Act 1983, and … in regulating the provision of mental health services”.

We have also included proposed new subsection (3), which would ensure that the review of the CQC’s functions will also include an assessment of whether it will be able to “effectively carry out” its new duties under the Bill.

As the Minister will know, in May 2024, Dr Penny Dash was commissioned to conduct the independent review of the operational effectiveness of the CQC. The full report, published in October, found

“significant failings in the internal workings of CQC which have led to a substantial loss of credibility within the health and social care sectors, a deterioration in the ability of CQC to identify poor performance and support a drive to improved quality—and a direct impact on the capacity and capability of both the social care and the healthcare sectors to deliver much needed improvements in care”.

In addition, my noble friend Lord Howe raised the issues arising from his meetings with the charity Blooming Change on a number of occasions. It has raised serious concerns about the CQC’s monitoring activity. We also know that the Secretary of State himself has claimed that the CQC is not fit for purpose, and that there are some fundamental issues with how the CQC oversees the mental health care system.

As we have heard from other noble Lords, one solution would be to have an independent mental health commissioner. Our solution is to call for a review of the CQC that specifically focuses on its mental health functions, to make sure that it does its job properly. The review conducted by Dr Dash comprehensively assessed the CQC’s ability to regulate primary, secondary and community care, but it did not focus on the sufficiency of mental health care regulation. I thank the Minister for the brief meeting with my noble friend and me earlier this week, in which she indicated that she would be able to give greater assurances on this particular issue. I look forward to what the Minister has to say on it, because this is part of our justification for not supporting the mental health commissioner: we want to see a strengthened CQC. We do not want duplication, but, in avoiding duplication, we want to make sure that the CQC does the job it is supposed to do. I hope I can get that assurance from the Minister when she speaks.

I have some sympathy with Amendment 61, in the name of the noble Baroness, Lady Fox, in line with the comments of the former Prime Minister, Tony Blair, but I also have some sympathy with what the Secretary of State said. We thought about whether we could find an appropriate amendment to table on this. We have to be very careful and sensitive about this issue: we in Parliament or officials in Whitehall cannot hope to pronounce on the issues individuals face in their homes or communities. It is about getting the balance right.

The noble Lord, Lord Alderdice, also spoke about the concerns about overdiagnosis, but we cannot just make a generalisation. We have to make sure that the mental health professionals are doing their job, with the right guidance, to ensure that we understand the needs of each individual. For that reason, I thought it was far too difficult—and it would have been insensitive —for me to lay an amendment on this topic. I did not want to go there for that reason. This is an issue that has to be discussed, but we have to do it in the most appropriate way—in a sensitive way that understands those who suffer seriously from mental health conditions.

Let me turn to the amendments tabled by the noble Baroness, Lady Tyler. She and I have both raised the issue of racial disparities. In Committee, I went in very strongly on it—this is the issue that matters to me personally very much, and I shared some of my own experience of racial discrimination. I am as frustrated as everyone else that we still have not resolved the problem to this day; we still do not understand why, disproportionately, black men in particular are subject to detentions and community treatment orders. I asked questions at the time. What do we know? What do we not know? What are we doing to fill that knowledge gap? Once we have filled that knowledge gap, what are we going to do about it? Once again, I thank the Minister and her officials for the detailed meetings that they had with us when they laid out some of the things that they are doing. Could I tempt her to share with noble Lords some of that discussion and her letter, to assure us all that the Government really are on top of that issue, know what they are doing and are going to address these problems?

I was unsure about how effective the provision in Amendment 49 would be. I know that it is not very fashionable for politicians to say, “I don’t know”; we are supposed to make a firm decision one way or the other and agree or strongly disagree. But I wanted to reflect on whether that amendment would represent an additional burden on the healthcare professional, additional cost or additional bureaucracy. Given that we cannot, at this stage, say for sure how this will turn out, I support the suggestion of the noble Baroness, Lady Tyler, to pilot a scheme of a senior responsible person to address racial disparities. If we could pilot it in some places, it would give us the data to understand whether a responsible person would be effective in addressing those disparities. We all know that more needs to be done. We have had successive Governments of all political colours, and we still have not solved this problem. Let us be determined, as a House, whichever party we are, to tackle this problem of racial disparities, and let us make sure that we do it in the most effective way.

I am grateful for what the Minister said on Monday, but I hope that she will give some consideration to what the noble Baroness, Lady Tyler, said about piloting a responsible person to see whether that works. Maybe it will not work, but at least we would have the data and evidence. I would appreciate the Minister giving a more detailed explanation of some of the research that is being conducted to fill that gap, so we can understand why there are still racial disparities and what Governments of any political colour would have to do to address them.

Mental Health Bill [HL]

Debate between Baroness Browning and Lord Kamall

Committee stage
Wednesday 22nd January 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, Amendment 57 stands in my name and that of my noble friend Lord Howe. The amendment is an attempt to ensure that patients who are admitted informally to hospital for a mental health disorder are also able to benefit from a care and treatment plan. As noble Lords will be aware, the Bill introduces statutory care and treatment plans but, as drafted, extends that right only to a select group of patients. As per the new Section 130ZA(2) of the Mental Health Act, patients who will be eligible for these plans are those who are formally detained under that Act, those who are subject to guardianship under the Act and those who are under a CTO.

I do not think there is any disagreement that these patients rightly deserve access to a care and treatment plan. But what about informal patients who voluntarily admit themselves for treatment? The Explanatory Notes explain that the purpose of putting these plans on a statutory footing is

“to ensure that all relevant patients have a clear and personalised strategy in place describing what is needed to progress them towards recovery”.

They also detail some of the possible inclusions in that care and treatment plan.

I note, however, that the exact inclusions in the care and treatment plan are to be made by the Secretary of State by regulations at a later date, possibly due to consultation. So, although we may have some idea of what might be included, it would be helpful if the Minister could confirm to your Lordships what the Government envisage will be included or could be included. I am not wanting to put the noble Baroness too much on the spot here.

As many noble Lords might well know, care and treatment plans have been part of the package of mental health treatment in Wales since June 2012 under Section 18 of the Mental Health (Wales) Measure 2010. Those regulations specify that the areas that must be included in the patient’s care and treatment plan include

“finance and money … accommodation … personal care and physical well-being … education and training … work and occupation … parenting or caring relationships … social, cultural or spiritual … medical and other forms of treatment including psychological interventions”.

Can the Minister confirm whether the care and treatment plans in England will follow the same format or possibly be inspired by the same format? Will there be differences? Are there England-specific issues?

I hope the Minister will understand that I have a few more questions. How will the Secretary of State decide what to prescribe in these plans? What level of consultation will there be? Indeed, what level of consultation has there been to date to inform this, particularly with the clinicians who will be responsible for drawing up the care and treatment plans?

One of the things that many noble Lords have discussed during this debate is the fact that we want to see evidence-led practices. We know that, particularly in mental health but also in physical health, these can help to inform care and treatment plans that have a positive impact on clinical outcomes and therapeutic benefit, because they are based on treatments unique to the patient’s needs.

A meta study in 2023 in the United States found that evidence-based practices

“improve patient outcomes and yield a positive return on investment for hospitals and healthcare systems”.

I note the Minister has referred a number of times to the Government making and implementing these changes when resources allow.

The Social Care Institute for Excellence has also highlighted the importance of person-centred care, writing:

“Research on mental health and wellbeing demonstrates that involvement leads to improved service outcomes and enhances mental wellbeing”.


The institute argues forcefully that care plans for mental health patients should include active involvement from the patient. It is therefore vital that care and treatment plans are not developed in a silo; they should be developed in conjunction with the patient. Given the benefits that access to care and treatment plans should bring patients with a mental disorder, it would be more than appropriate for informal patients to be included as well.

If anyone actually listened to what I said in the debate on our second day in Committee, they may be aware that I had some sympathy with the point made by the noble Baroness, Lady Murphy, who is not in her place. She argued that she did not want to extend the independent mental health advocates to informal patients, possibly because of resource constraints but also because of limited evidence on their therapeutic benefit. I could be accused of being inconsistent, but I would say that, for care and treatment plans, the issue is rather different.

The clinicians will draw up these plans. The Bill states that it is the “appropriate practitioner” who will already be treating that patient, so it may not be the same issue of resources. Perhaps it will take extra time, and I understand that time adds up the more you require of a clinician. But, given that the informally admitted patient will already be being treated by a clinician, we would not necessarily be adding much resource or burden on to the clinician, in the same way as if we had extended the IMHAs, as in the argument made the other night.

Therefore, I hope this amendment will extend provisions that will benefit informally admitted patients, as they will benefit the patients already decided upon in the Bill. I beg to move.

[Baroness Browning (Con)]

My Lords, I have added my name to this amendment. I will not detain the Committee long, but I support the amendment and I want to flag the point my noble friend made about Wales and England. To my certain knowledge, when people living further north around the Shropshire border, for example, are admitted, they will almost certainly be offered placements in north Wales. It is important that there is some harmony in these regions; otherwise, it will cause additional problems. I hope my noble friend will press his amendment in due course to make sure that that harmony exists.