Mental Health Bill [HL]

Baroness Buscombe Excerpts

2nd reading
Monday 25th November 2024 Lords Chamber

[Baroness Buscombe (Con)]

My Lords, it gives me enormous pleasure to speak in this debate. For me, this legislation is above politics: it is a real opportunity for constructive opposition. I welcomed the call in July from the Secretary of State for Health, Wes Streeting MP, asking whether I would support the Bill and assist in its progress. Yes, there are some aspects of the Bill on which we on these Benches will wish to press the Government. However, our view is that it is overdue and critical for so many people who have felt misunderstood and suffered serious neglect for too long.

I feel lucky to have chaired the Joint Committee on the Draft Mental Health Bill. Everyone on the Committee apart from me had professional and practical expertise and experience and/or powerful personal experience and knowledge through friends and families. We received evidence from more than 50 organisations and many people who were service users, to whom we remain eternally grateful. We had many hours of strong debate and always managed to find a way through. Results sometimes involved compromise but were also consensual. I thank each and every member for their invaluable contributions, together with our advisers and the brilliant Alex Ruck Keene KC for his extraordinary drafting skills. I also thank the clerks and officials who worked skilfully against a very strict timetable.

I pay tribute to all our medical staff who work in this complex and, in many ways, challenging field of medicine. My sincere admiration for them, and the difficult choices and decisions that they must make, knows no bounds.

A key point for me—I speak as a lawyer—is that so much that directly affects the well-being of patients must be improved, not necessarily by legislation, which can hamper positive change, but through a step change in culture in order to genuinely value every individual and improve their life through choice, dignity, support and advocacy. The Bill seeks to address that, although it lacks a key tool: the use of technology and the drive for data, which I urge the Minister to consider.

The process of amending the current Act speaks volumes. Would that we could have torn up all the current Acts and started again with a fused approach to treating mental health, but we were persuaded that that would just take too long. It has taken too many years to get this far, and now change is urgent.

I have time to touch upon just a few of the many aspects of the Bill. It is right that the Government have agreed—here I say to the noble Baroness, Lady Barker, that we have good news—to embed in primary legislation what I call the Wessely principles: choice and autonomy, least restriction, therapeutic benefit, and the person as an individual. Each principle should be tested against the implementation of current proposals, future reform and change to ensure that patients as individuals remain the heart of the matter.

Least restraint is a key reason for reform, although in practice it is a difficult balance to strike. As the Wessely inquiry report makes clear, as a society we now benefit from a greater understanding of mental health. However, at the same time society has become much more risk-averse. Much of our debate centred around the need to address all avenues of least restraint, particularly given the current inequalities of outcomes, against the risk of unintended consequences for the protection of society and the therapeutic benefit of the patient.

To apply the principles, we need the data to track every patient and their outcomes. I remain appalled at the lack of information and communication across the NHS, which has a negative impact upon so many lives. Each time a person is moved, they are registered as a new patient. How much does that contribute to flawed data and poor outcomes? I urge the Minister to look at that.

A key missing element is technology, as I have said, and I do not mean some clunky, one-size-fits-all NHS-wide system. In short, we need to swiftly develop a national dataset to allow for real-time monitoring and accountability, evaluating variation and inequalities, understanding medium- and long-term trends and informing future policy decisions.

For choice, dignity and autonomy, we recommended a statutory right for patients who have been detained under the Mental Health Act to request an advance choice document to be drawn up and recorded in a way that is accessible digitally. There is no mention of digital in the Bill. Instead, it introduces duties on integrated care boards, NHS England and local health boards in Wales to make arrangements so that people at risk of detention are informed of their ability to make an ACD, a written statement, and be supported to make one.

Our report referenced the potential for creating ACDs via an app, similar in some ways to one already working for end-of-life palliative care, to support all patients. Simply put, it is a no-brainer and transformative, easily accessed by anyone, either on a mobile phone or even on a patient’s clothes, so that when that person is in crisis there is an instant critical guide to who that person is. That would greatly assist the police, if they are in attendance, and those in A&E. I am hopeful that this approach and other smart, cost-efficient moves will be in the code of practice.

The implementation of reform requires constant oversight. We recommended the appointment of an independent mental health commissioner with overarching responsibility to ensure consistency of delivery of the Government’s priorities for patients across England and Wales. This is not about the Government losing control; on the contrary, it is about an overarching small body with the ability to focus upon consistency across the whole sector, ideally using digitised national data to track and monitor the implementation of the reforms over a period of years, working with the associated NHS bodies to promote better outcomes. I ask the Minister: who else will do that?

Furthermore, we must address unacceptable racial disparities and inequalities, particularly among black men, who, as we have heard from my noble friend Lord Howe, are three and a half times more likely to be detained under the Mental Health Act and seven times more likely to be placed on a CTO. But how is that data collected and verified? Indeed, the facts could be worse. Our report was clear that better outcomes would be achieved and inequalities reduced if each health organisation introduced culturally appropriate advocacy and appointed a responsible person to collect relevant data and publish and oversee policies to address these inequalities. A mental health commissioner could ensure that that was done.

Mental health services currently operate in a static world. What happens when someone has a crisis far away from their local authority? We heard on a visit to SLaM in Lambeth that patients sometimes travel miles to Lambeth when on a downward spiral to receive, in their view, better treatment there than within their local authority. That is another reason to have accurate data.

Another critical area is children and young people. Issues highlighted in our report, including the role and profile of nominated persons, detention in adult wards and conflict with the Children Act, must be clarified and assurances given to families and their young. Investing in and building the right community support and action plan for people with learning disabilities and autism no longer detained under Section 3 is critical, as is monitoring the outcomes for those with learning disabilities and autism who may be at risk of being detained under the Mental Capacity Act or through the criminal justice system instead. This is an area where our committee had a strong debate, concerned about unintended consequences that might impact on the patient and/or society at large if the right protections, including safe spaces, were not in place. Are the Government content that they have achieved the right balance?

I feel I must record—because I want to be helpful to the Government—that our committee had one opportunity to put some of the crucial questions to, and test the opinions of, around 18 officials from the DHSC and the MoJ who had worked on the Bill for four years. That meeting was cut very short because one official said she had to collect her child from school, so all 18 walked out. That must not be allowed to happen again.

Priorities must be set for the implementation of the many proposals, and there needs to be a significant increase in capacity right across mental health services, all of which requires enormous investment. I wish the Government, particularly the noble Baroness, Lady Merron, well.

Mental Health Act 1983

Baroness Buscombe Excerpts

Tuesday 21st November 2023 Lords Chamber

[Lord Markham (Con)]

I understand the frustration and disappointment about the fact that the Bill has not been brought forward. I am keen to focus on what we can do in the meantime. Of course the Bill is trying to decrease the rate of detention and, within that, decrease the racial disparities, such as the fact that a black person is four times more likely to be detained than a white person. There are a number of things that I hope we will be able to discuss more, particularly in the debates on Thursday as well, such as the things we have introduced in pilots, like the culturally appropriate advocacy. That really can make a difference here and now.

[Baroness Buscombe (Con)]

As the chairman of the inquiry, I reassure noble Lords that my noble friend the Minister is very aware of our frustration. However, I am pleased to hear—I am sure others are too—that, along with others in the department, he is looking to see what we can achieve without primary legislation. Could he and his officials focus on the further development and implementation of, for example, advanced choice documents, which would really make a difference to the dignity and choice that people with mental health issues thoroughly deserve? Could he also, as he touched on, really research and respond to why a highly disproportionate number of black men are unfairly detained?

[Lord Markham (Con)]

I thank my noble friend for her question and for her work on this. The advanced choice documents are a perfect example, like a birth plan, of where people can put in place what their hopes are for the future. There are good examples at King’s College and at South London and Maudsley of what they are doing in this direction, and I am really keen to learn from those and expand them further. I am also keen to invite all the participants to a round table that Mental Health Minister Caulfield has agreed as well, where we can really talk about the action that we can take on the ground to implement as many things as we can to rectify the problems in this space.

Mental Health In-patient Services: Improving Safety

Baroness Buscombe Excerpts

Monday 3rd July 2023 Lords Chamber

[Baroness Buscombe (Con)]

My Lords, I would like to begin the questions, as chair of the recent Joint Committee on the Draft Mental Health Bill. I say to my noble friend the Minister that we accept—I accept, certainly—that this Government are committed to improving mental health care across England. However, there is a strong sense of disappointment. Having published this report on 15 January, after a huge amount of work—I am proud to say it was an incredibly collegiate cross-party committee, across both Houses, and we came up with 55 recommendations with great care—we have had one short note from the Minister in another place, Maria Caulfield MP. It said that there was much consideration going on, and obviously both the Department of Health and Social Care and the Ministry of Justice are involved. The note said the response was in an advanced state and that we would be hearing from her in due course. However, we are now in July.

I believe it is hugely important that the Government demonstrate, rather more than they have so far, their commitment to improvements across the piece in mental health care. We are in a good place on support, but that support will wane unless the Government can really show commitment. I know there is an issue with the parliamentary timetable and so on, but the Government could at least respond to our 55 recommendations.

In addition, I have suggested to the Secretary of State a couple of things that could be done prior to legislation—in fact, a number of things in our report could be implemented without primary legislation. For example, on 26 February, I was actually quite unwell but I still met some civil servants at the Department of Health to discuss an incredible app that has already been developed for the palliative care world to support people in crisis. This app could be easily translated at very reasonable cost to support people having a mental health crisis. I was accompanied by—

[Noble Lords]

Question!

[Baroness Buscombe (Con)]

A question is coming. I was accompanied by a brilliant consultant, Julia Riley. She has not even had a cursory note of thanks from those civil servants. Could the Minister therefore please respond by giving a little more detail on the timing? Could he also let me know whether there has been any progress on developing that particular app? I would also like to know about the implementation of safe places, where people can go when they are in crisis.

[Lord Markham (Con)]

I thank my noble friend for her tireless work in this space. We believe that a number of constructive points were made in the committee report, which I know Maria Caulfield is working on and looking to get a timely response to. Maybe that is something on which we can meet up and discuss later.

Mental Health Act Reform

Baroness Buscombe Excerpts

Thursday 26th January 2023 Lords Chamber

Asked by

[Baroness Buscombe]

To ask His Majesty’s Government what reforms they are proposing to the Mental Health Act 1983.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

The Government published their draft mental health Bill on 27 June 2022, which contains our intended reforms to the Mental Health Act 1983. I am grateful to the joint pre-legislative scrutiny committee on the Bill for its report, which was published last week, on 19 January. The Government will now review the committee’s recommendations. We will respond in the coming months and introduce a revised Bill when parliamentary time allows.

[Baroness Buscombe (Con)]

I thank my noble friend the Minister for his comments on the Joint Committee’s report. I had the privilege of chairing its inquiry and I am grateful for the contributions of Members of both Houses. The Government must of course spend time considering with care our recommendations, but as a committee we feel strongly that a Bill should be introduced to Parliament as soon as is practicable to bring about the really important reforms to the mental health system that people so dearly deserve. Will my noble friend give an assurance that the Government will introduce a formal Bill to Parliament in the current Session?

[Lord Markham (Con)]

First, I thank my noble friend and all noble Lords who took part in the pre-legislative scrutiny committee. I think all noble Lords agree that what we are trying to do with the mental health Bill is a very good thing. We would like to bring it forward as soon as we can. From my side, I know that we are ready to go, but we are working with the parliamentary authorities to make sure that we can get the legislative time. We want to do it as soon as possible.

Respiratory Syncytial Virus

Baroness Buscombe Excerpts

Thursday 19th January 2023 Lords Chamber

[Lord Markham (Con)]

I can report best on nirsevimab, which has just been licensed, is shown to be 75% to 80% effective in the trials and has the approach of immunising people for six months. I am aware of Pfizer developing a maternal vaccination for whooping cough, which will give the baby immunisation through the mother. The House will also be aware of the recent announcement we made with Moderna on the investment in new R&D facilities here, so that we are at the forefront. I hope the noble Lord can see that we are looking at all these new innovations and will roll them out.

[Baroness Buscombe (Con)]

My Lords, have we not learned some lessons, from Covid and long Covid, of the need for children, babies and all of us to build our immune systems? Long Covid is proving that we have a real problem. I caught this virus from my granddaughter, a baby. I am told that the more she catches these wretched things now, the healthier she will be and the better she will be at putting off some serious diseases later in life. While accepting that high-risk babies obviously need particular regard, is it not right that we should be mindful of continually looking for a vaccine every time a new virus is discovered?

[Lord Markham (Con)]

My noble friend is correct in that, for the vast majority of people—infants in this case—it is mild, flu-like symptoms at most. At the same time, it is responsible for 35,000 hospitalisations and 20 to 30 deaths a year, so it is a serious thing that we need to get on top of. We are looking for the best of both worlds. That 90% of two year-olds will have had RSV and so will have that natural protection is a good thing. But in the most serious cases—the risk groups are those with congenital lung or heart disease or spinal muscular problems—these new treatments really will help and are very important.

Abuse and Deaths in Secure Mental Health Units

Baroness Buscombe Excerpts

Wednesday 9th November 2022 Lords Chamber

[Lord Markham (Con)]

I agree, and I have been asking similar questions around whether we should be looking for a special measures-type regime in this space. To be fair to the new CEO, who has come in from 2020, he has set out a plan and progress is being made on many steps. It is the focus of the Minister to see whether that progress is quick enough. We understand that staffing is a key issue. We have increased the number of staff by 24,000 since 2016, and almost 7,000 in the last year alone. Clearly, part of this rapid review needs to be around staffing.

[Baroness Buscombe (Con)]

My Lords, I currently chair the Joint Committee scrutinising the draft mental health Bill. This is an important Bill and is the subject of both Houses on a cross-party basis. We hope to publish our recommendations in the middle of January. Will my noble friend reassure me and the whole House that great care will be taken to consider the recommendations we put to the Government and that an early response will be brought forward in the light of the fact that it is incredibly important that we see this legislation through as soon as possible?

[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.

Covid-19

Baroness Buscombe Excerpts

Thursday 23rd April 2020 Lords Chamber

[Lord Bethell]

The noble Baroness, Lady Meacher, is entirely right in the way that she explains things. The driver of that decision is the need to get our prevalence rates and the velocity of the infection down to a reasonable level, so that we have reasonable resources to keep R down by track and trace. I remind her that South Korea, which has used this technique most effectively, does only 20,000 tests per day, because its prevalence levels and velocity of infection are so low.

[Baroness Buscombe (Con)]

My Lords, I should like to say how encouraged I am by what my noble friend the Minister has said today on the progress made in tackling this virus. In asking my question, I stress that I have been urged so to do by many businesses, large and small, across the country—the backbone of our economy.

Will the Minister and his colleagues now accept that we must expect a second wave of the virus, even though we do not know when? If so, it is now crucial to look at working both with and beyond the science, and to take a balanced, proportionate and, frankly, brave decision, with Cabinet colleagues, to put trust in the good sense of the public to ease the lockdown as soon as possible—to allow the economically active to return to work, while retaining sensible social distancing —given that the situation is now having a devastating effect on our economy, and on our ability to afford our NHS, our welfare system, education system and other public services into the future.

[Lord Bethell]

I note my noble friend Lady Buscombe’s question, but I reject the sentiments behind it. I do not regard a second wave as inevitable; I do not share her fatalism. The priorities of the Government are to save life and to protect the NHS and our care system. That requires us to lower the prevalence level, reduce infection and put in place systems such as track and trace to keep a lid on the disease so that we can protect life and our systems.

Health: Maternity Care Provisions in East Kent

Baroness Buscombe Excerpts

Thursday 13th February 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

My noble friend is, as ever, very wise on this. A key plank of the maternity safety strategy, launched in 2016, is a number of initiatives to improve not only clinical care but culture in maternity services. They have been designed to improve leadership and to ensure that in every trust there is a midwife, an obstetrician and a board-level maternity safety champion to spearhead improvement. It is critical that we ensure that this is delivered so that incidents such as this do not occur.

[Baroness Buscombe (Con)]

My Lords, there is no question but that our maternity services across the piece are under enormous pressure. We know that in 2017, somewhere between 30% and 40% of all babies born in the UK were born to foreign nationals. Will the Minister tell me, in broad terms, do foreign nationals, when they have babies in this country, make a financial contribution?

[Baroness Blackwood of North Oxford]

People are entitled to free NHS care if they are ordinarily resident in the UK. However, my noble friend’s wider point about the pressure on maternity services was absolutely right. That is why, in February 2018, the Government announced an additional 3,650 training places for midwives. I am pleased to say that the first 650 began their training in September 2019 to ease the pressure, and there will be 1,000 training places for each of the next three years. This should ease the pressure and address some of the concerns my noble friend raised.

National Living Wage: Social Care

Baroness Buscombe Excerpts

Thursday 5th May 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, if I sounded complacent, I did not mean to. I recognise that there is tremendous pressure on many providers of adult social care, particularly those funded by local authorities. It is for that reason that—disappointingly, frankly—Dilnot has been postponed. We wanted to bring in Dilnot but we decided that the cost of bringing it in was too great for local authorities to finance in the short term, although we are committed to doing it in the long term. The Government have allowed local authorities to raise a 2% precept and will be increasing the better care fund by £1.5 billion at the end of the period, bringing the total to £3.5 billion. It is a tough settlement—no one is making any bones about that—but tough choices have to be made.

[Baroness Buscombe (Con)]

My Lords, related to this is the whole issue of the better care fund. I think that Ministers will accept that while the better care fund is quite right, the delivery of it has not been properly thought through. In which case, what steps are the Government now taking to ensure that the better care fund is directed towards innovation in social care provision, to stimulate more cost-effective care in the community?

[Lord Prior of Brampton]

My Lords, the better care fund should be seen in a longer-term context of bringing together health and social care. The sustainability and transformation systems that are now being developed are the logical extension of the better care fund. Until prevention, healthcare and social care are brought together in a single budget, it will be extremely difficult to ensure the right allocation of resources.

Young People: Suicide

Baroness Buscombe Excerpts

Thursday 27th February 2014 Grand Committee

[Baroness Buscombe (Con)]

My Lords, I, too, thank the noble and right reverend Lord for obtaining this valuable debate. I also declare an interest, of which I am very proud, as chairman of the advisory board for the Samaritans. I want to talk about how both government and the private sector are working to try to reduce levels of suicide. I will focus upon the internet and the need for free phone numbers to break down access to help and support, particularly among young people.

There has been considerable debate in recent weeks about the influence of the internet and social networking sites on young people vulnerable to suicide. The truth is, it is much more difficult to reduce access to potentially harmful information when it is online. The Samaritans has been focusing on this for a number of years, and its experience shows that the most effective approach is to both expand the sources of support to vulnerable people online and also to encourage organisations which run highly popular sites to develop responsible practices and to promote sources of support.

In pursuing this approach, the Samaritans have worked in partnership with major companies to develop practical initiatives to support people at risk of suicide online. In November 2010, an initiative was launched in partnership with Google which adds a new feature to search results. The Samaritans helpline number and a highly visible telephone icon is now displayed above normal Google search results when people in the UK use a number of search terms related to suicide. We have also launched a pioneering new scheme in partnership with Facebook which allows the 30 million Facebook users in the UK to get help for a friend they believe is struggling to cope or feeling suicidal. People who are concerned about a friend on Facebook can report suicidal content such as status updates or wall posts through the help centre page on the website. The distressed person then receives an email from the Samaritans offering to open a line of communication with a volunteer so that they can access our services.

We also expect organisations that run these websites, such as social networking sites and online news media outlets to take action to reduce the availability of harmful content hosted on their sites. As part of the Samaritans media monitoring work, we contact newspaper staff directly to suggest amendments to the online version of articles with potentially harmful content.

One of the main difficulties in reducing the risk of suicide online is that the current research on the internet and suicide is extremely limited. The Samaritans are therefore working on new research in partnership with the University of Bristol, funded, I am pleased to say, by the Department of Health’s policy research programme on how people with suicidal feelings use the internet and the impact that this has on suicidal behaviour. We are hopeful that this research will provide new evidence to help to inform policy and best practice.

However, an important element of suicide prevention is that support is immediately available to people in distress, and that people know how to access it. The Samaritans national helpline number currently uses an 0845 prefix, which means that, while calls from landline phones are relatively inexpensive, calls from a mobile phone can cost considerably more. Several years ago, the European Commission decided that certain services of social value should have the same memorable telephone numbers in all member states, and should be free. In 2009, therefore, Ofcom awarded such a number to the Samaritans, which has since launched a successful pilot of this new free number in limited areas.

The problem is funding. At the moment, thankfully, the Big Lottery Fund is funding the rollout of the free-call service in just 10 areas, targeting those most in need of a free-to-caller service. This will allow Samaritans to understand how a free-to-caller number targeting people in socioeconomically deprived areas will change the nature, volume and pattern of calls. But the issue that Samaritans urgently needs to resolve is how to make the service financially sustainable in the long term.

Here I turn to a debate on this subject that I initiated in your Lordships’ House last July. Following that debate and the very helpful, supportive response from my noble friend the Minister, the Department of Health agreed in principle to host a round-table meeting with the telecoms industry and Ofcom to discuss how the telecoms industry and others can fund free-call for the longer term. This was discussed when the CEO of Samaritans met Norman Lamb in October and it was agreed that this meeting should take place. A suggested list of stakeholders has been submitted to the Department of Health. We understand that the meeting is still in the pipeline, but progress is slow and there is still no date for the meeting in the diary. I urge my noble friend the Minister to follow this up.