Mental Health Bill [HL]

Baroness Fox of Buckley Excerpts

Committee stage
Monday 20th January 2025 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, I will speak to my Amendments 67 and 86. I think that this is the right place—I apologise for my earlier confusion; I had a problem with the list.

I will start with Amendment 86 because it follows on from the very important contribution from the noble Lord, Lord Scriven. I should preface this by saying that I cannot claim that what I will say originates from me; it is based on the Law Society briefing, which many noble Lords will have received. I saw that nobody else had picked up this amendment, but I thought that it was so important that it should be picked up. As the explanatory statement says:

“The amendment would keep the safeguard of an automatic referral to the tribunal when a patient’s Community Treatment Order is revoked which results in them being detained in a mental health hospital”.


As the noble Lord, Lord Scriven, said, a range of views on CTOs has been expressed in these debates, but the general direction of travel is certainly not to remove safeguards and we should be keeping the safeguards that already apply. I will not claim great expertise on this, but it seemed to me that this is an important issue that we need to discuss in Committee.

Amendment 67 is somewhat different but really important. Later on, we will discuss very important issues, which I have signed amendments about, concerning minoritised communities being potentially overtargeted or subjected more to mental health provisions. This amendment picks up something that no one else has picked up, which is economic and social disparities relating to community treatment orders. I went looking for some statistics on CTOs in disadvantaged communities, but I was not able to split them out; perhaps the Minister has them. However, the charity Rethink Mental Illness talks about the burning injustice of how Mental Health Act detention rates are three and a half times higher in the most deprived areas of England compared with the least deprived. Looking at those figures, I can only see that CTOs must be something very similar to that.

We need to ask a question here, and we need the stats and that is why we should have the reporting. It is probably unclear whether we have a psychiatrisation of poverty, so that when people are living in conditions of poverty, that is seen as some form of mental illness in itself, or a discriminatory application of the law against people living in conditions of poverty. The third possibility is that poverty is making people ill. Either way, we should know about these facts. They should be regularly reported, and we should be able to examine them and check on them.

I was just looking at an issue that will be raised later about debt and mental health, on which I will point noble Lords who have not seen it to a really interesting POSTnote that the Parliamentary Office of Science and Technology produced on that subject last year. It suggests a two-way relationship between financial and mental well-being. People with mental health issues are three or more times more likely to have problem debt.

Some interesting recent research in a study published in Public Health indicates how social conditions are related to mental health. “Sandwich carers” in the UK —the 1.3 million people who have responsibility for caring for children and older parents—have experienced a significant decline in mental health.

These issues around social and economic disparities and the use of community treatment orders are embedded in the community, and it is crucial to see what is happening. Amendment 67 aims to ensure that we get regular reports relating to community treatment orders.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I wanted to speak to this group because I made some harsh criticisms, on principle, of community treatment orders at Second Reading concerning their coercive and intrusive nature. Since then, perhaps similarly to the noble Lord, Lord Scriven, I have had cause to think again, not least after speaking to a number of working psychiatrists and taking on board the comments of the noble Baroness, Lady Parminter, at Second Reading, which really had an impact on me. It is quite unusual to change one’s mind in this place—maybe it is just me—so I wanted to note that.

I was reminded of this issue by practitioners—I was once one of those—when they said, “We worry about how many idealistic discussions about mental illness just do not take into account the reality of chronic mental illness”; I thought that was a fair reprimand. There are a group of people who are chronically symptomatic, perhaps some of them may never be well, and CTOs are a way to allow people to leave hospital who otherwise clinicians might worry would be too risky to release.

I have been thinking about this issue and in that sense was happy to see and support Amendment 44 in the name of the noble Lord, Lord Scriven, which sets out time limits. It is useful to think about probing time limits, renewal safeguards and so on, because one does not want automatic continuation and therefore indefinite CTOs on the books, which is what people are concerned about.

I would have been more enthusiastic about Amendment 66, put forward by the noble Lord, Lord Kamall, and the noble Earl, Lord Howe, which calls for a statutory review of CTO use, but the wording implies that CTOs are problematic per se. Perhaps we need a more open-ended review, because one of the reasons why CTOs are so contentious for so many people is their spiralling and increasing use, and we need to understand why that is.

One worry I have about the Bill in general, and not just this group of amendments, is that, because the drivers of the legislation are concerns about inappropriate hospital admissions and wanting to ensure that we have proportionate detention powers which are used only as a last resort, we need to be wary of demonising hospital care and recognise how much good can be done for mentally distressed patients in hospitals, particularly if they are given time and resources and the right kind of medical intervention. But, as with all hospital matters, that is not necessarily what is happening. Many psychiatric wards are under pressure to get people out into the community as soon as possible—in the sense not of them being well, but of freeing up hospital beds. One might wonder whether the CTOs are a mechanism for effectively turfing patients out before they are ready or well enough.

It also seems that CTOs are necessary when community care is under huge strain, because the idea of voluntarily accessing a wide variety of support in the community is a myth in today’s circumstances. All the briefings we have been sent draw attention to this. A range of groups and people have argued—and a number of noble Lords have said this today—that we need more resources, money and staff for appropriate care in the community to really work. That sounds reasonable, but I am concerned that this will miss the target. I want to reiterate the elephant in the room that I mentioned at Second Reading, which I have not changed my mind about: culturally, we are seeing the medicalisation of more and more problems of the human condition. This encourages ever greater numbers of people to view social, economic, educational and personal difficulties through the prism of mental health.

NHS: Single-sex Provision for Staff and Patients

Baroness Fox of Buckley Excerpts

Wednesday 8th January 2025 Lords Chamber

Asked by

[Baroness Fox of Buckley]

To ask His Majesty’s Government whether they plan to issue guidance relating to single-sex provision for NHS staff as well as patients.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, all employers, including the NHS, are required to comply with existing law on single-sex facilities. In these cases, a common-sense and empathetic approach is needed. It is important that service providers have clear guidance about the Equality Act. We will consider whether further guidance is needed, including on how lawfully to apply its single-sex exemptions.

[Baroness Fox of Buckley (Non-Afl)]

I thank the Minister for that reply. I know that the Government value front-line health workers and I am sure that they are concerned to hear that NHS trusts are allowing ideology to deny nurses safety, privacy and respect at work. I am disappointed, however, that action is not more immediate. The Secretary of State, Wes Streeting, said that he was horrified by the case of the Darlington nurses being forced to share their changing facilities with a male colleague who identifies as female. Does the Minister agree that trusts need urgent guidance on this issue? I know that the Darlington nurses have submitted draft guidance to the department—

[Noble Lords]

Question.

[Baroness Fox of Buckley (Non-Afl)]

Okay, the question is: can that guidance be brought forward, because nurses are being bullied and harassed at work around this issue?

[Baroness Merron (Lab)]

I am not sure that I can agree with the noble Baroness about trusts being driven by NHS ideology. All staff should be and must be treated with dignity, with their safety and privacy respected. Much of this is about practicalities and working with staff in the same way that other policies are worked with, and I would expect a common-sense and sensitive approach to prevail. The Secretary of State did indeed meet with the five nurses from Darlington regarding their concerns about single-sex spaces. We have indeed received a draft version of the guidance that they have produced and will reply to them at the earliest opportunity. However, the guidance that I would focus on is from the Government. We are looking at how we can assist all employers in complying with legislative requirements.

Puberty-suppressing Hormones

Baroness Fox of Buckley Excerpts

Monday 16th December 2024 Lords Chamber

[Baroness Merron (Lab)]

I do not recognise the last point that the noble Baroness made about the time. The aim is to start recruiting participants in spring next year and, as I mentioned, the National Institute for Health and Care Research is working with NHS England to develop the clinical trials. They are the first in the world and I will be very pleased to provide further information as and when it is available.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I commend the Secretary of State—and, indeed, the Minister. I commend the Secretary of State for his very clear Statement and for his courage, because he has had to stand his ground. He kept his cool, despite receiving unpleasant smears and abuse not only online, but even, to a certain extent, from the Back Benches in the other place.

I am slightly confused about something. I think we can see now that puberty blockers are a medicalised euphemism for chemical castration. The same kinds of drugs, when given to Alan Turing, were used as punishment for being gay. I am still not convinced, and do not really understand why the Government still think it is appropriate to conduct a clinical trial on children with these drugs. The Minister emphasised “uncapped” as though that was positive, whereas I thought that was scary.

As this medical scandal unravels, more and more young people are de-transitioning, but the NHS has no services to deal with this. I wonder whether the Minister would agree, perhaps, to meet some of the charities that are doing this kind of thing—there is Genspect’s Beyond Trans and its special service providers—just to discuss what the NHS might need to look at, moving forward in a different way.

[Baroness Merron (Lab)]

I very much welcome the generous and supportive comments of the noble Baroness, Lady Fox, in respect of the Secretary of State’s Statement. I am grateful for those. I note that she finds the reference to “uncapped” scary. I presented it as the way to gather the widest amount of relevant evidence, because that is a clinical trial; that is what is so important. The reason it is being done is that there is insufficient evidence and there has not been such a trial, and we need to do one for this particular situation.

In respect of meeting charities and others, the Secretary of State has been very keen to—what I would call—reset the relationship with various groups which all have different sets of thoughts on this. I have joined him in those meetings. He has also been meeting those with lived experience. We continue to do so. We have wanted to detoxify the debate, and those meetings have helped immensely. We will continue to have that listening ear.

Mental Health Bill [HL]

Baroness Fox of Buckley Excerpts

2nd reading
Monday 25th November 2024 Lords Chamber

[Baroness Fox of Buckley (Non-Afl)]

My Lords, it is somewhat humbling and not a little intimidating to follow so many insightful speeches from those at the heart of the issue. For me, as a bit of an amateur outsider, I broadly welcome the Bill, with some reservations that I will pursue in Committee.

For Second Reading, I suggest that we should always remember the cultural and political context of our deliberations and indeed definitions—I will come back to that. We also need to remember the lessons of history: locking people up for mental illness has been mired in ethical and political scandal over many years. We all can cite the former Soviet Union, where political dissidents were labelled mentally ill, but even in democracies it was not until 1973 that the American Psychiatric Association voted to declassify homosexuality as a mental disorder—and let us not forget those unmarried mothers who were sectioned in the 20th century.

However, even with this misuse of psychiatric power, it is still possible to be a defender of liberty—such as myself, I hope—and yet acknowledge the need for some people to have their liberty restricted because of their mental health. Many years ago, when I worked for Mind, this was a very polarising debate; but I argued then, and continue to believe, that when someone is severely psychotic, manic or out of their mind, psychiatric coercion is not a violation of individual autonomy. That is because the subject at that point in time—“at that point in time” is key—is not autonomous in any moral sense.

However, is release not different? And that brings me to the issue of community treatment orders. Along with others, I too would like them to be abolished. The general problem of CTOs was well explained by Dr Ken McLaughlin is his pamphlet Escaping the Straitjacket of Mental Health. In it, he makes the point that, while the case for compulsion can be justified at the point of hospital admission, when the patient is likely to be in an acutely psychotic state, can compulsion be justified at the time of hospital discharge when the patient should have mental capacity restored? Prior to 2007 and CTOs, on leaving hospital, an ex-patient regained their full rights of citizenship, including the right to refuse medical treatment. The problem of being released with a CTO is that you return to the community as neither a patient nor a citizen. This hybrid state is troubling in terms of compromising civil liberties.

I tend to agree with the noble Earl, Lord Howe, and others: at the very least I question why the Bill will allow indefinite CTOs to occur. I agree with the Centre for Mental Health’s call for the safeguard of time limits, and then CTOs could be extended only if there was proof of proportionality for the individuals concerned.

The question of indefinite “coercive orders” inevitably reminds us of the plight of the almost 3,000 prisoners held indefinitely behind prison bars under the abolished and discredited IPP sentence. Many of these people are incarcerated in prisons precisely because their mental health has deteriorated as they have been refused release, even on licence; a sort of unacknowledged section is happening here. What is more, shockingly, a wide range of experts now blame this very sentencing regime as the cause of IPP prisoners’ mental distress. The hopelessness—“psychological terror”, as it has been described—of never-ending sentences has literally driven prisoners to lose their minds, and even their lives through suicide.

So, while I am delighted the Bill will remove prisons from the list of places of safety, how does it help IPP prisoners? They are deemed too mentally unwell to be released safely. Their illness is derived at least partly from a shameful state mistake, yet IPP prisoners are coercively detained indefinitely in institutions that the Bill would have the state now deem as unsafe for those with serious mental illness.

One case that has recently attracted headlines illustrates an IPP prisoner’s plight as it relates to the Bill. Forty year-old Thomas White has served 12 years as part of his indefinite IPP for a non-violent theft of a mobile phone in 2012. According to his psychiatrist, Thomas developed his religious hallucinations and psychosis as a direct result of being on an IPP sentence. His sister Clara has been campaigning for over a year to have Thomas transferred to a hospital, but his recent assessment appointment was cancelled due to staff shortages. Clara notes despairingly:

“We waited a long time to have Thomas assessed again by the psychiatrist. We more than likely won’t get the assessment again. The system is nothing but criminal—people like my brother are being seriously failed”.


James Frith, the Labour MP for Bury North, agrees. He said:

“Thomas’s indefinite imprisonment has had a hugely detrimental impact on his mental and physical wellbeing. Thomas should be a patient, not a prisoner”.


Hear, hear.

Things are little better for the general prison population. The annual report from the Chief Inspector of Prisons complains of high healthcare staff vacancy rates and chronic recruitment and retention issues. In that context, Richard Garside, the director of the Centre for Crime and Justice Studies, concludes that the provision in Clause 35 to introduce a statutory target of 28 days for transfer from prison to hospital, while welcome, feels aspirational rather than practically implementable in the current system.

The broader crisis of staffing and resources and whether it will hinder the Bill, as we have seen in jails, is also mirrored outside the prison gates. Many briefings that we have all received for this Second Reading query whether the Bill will deliver its promises as a consequence of such problems.

I will now raise a related concern. I think that overstretched mental health services are not just a question of resources but rather a consequence of a recent cultural trend: the problematic medicalisation of more and more aspects of the human condition. Ever greater numbers of people are being encouraged—often by Government-backed policies—to view normal, if adverse or perhaps painful, life events through the prism of mental illness. As a consequence, a greater number of people now demand expert pharmacological or therapeutic intervention.

Over recent decades, this huge increase in classification in the psychological realm has moved the job of diagnosis far beyond the field of psychiatry. A veritable industry of counsellors, therapists and psychotherapeutic practitioners now label an ever-expanding set of behaviours as mental ill-health. As the number of labelled conditions has grown, those reporting that they suffer from such problems has risen exponentially. The stats bandied around are eye-watering. According to the psychologist Oliver James, a third of the adult population shows sign of “psychiatric morbidity”. The problems of worklessness and sick leave, which the Government are rightly tackling, seem dominated by those who have removed themselves from productive work because of mental health-related problems.

Student Minds reports that one in three students experiences clinical levels of psychological distress, but as it is now claimed that students might suffer PTSD if exposed to certain literary texts, it is difficult to assess the clinical authenticity of the so-called mental ill-health epidemic among the young.

The main thing is that the pathologising of ever more aspects of life has unintended consequences, some pertinent to the Bill. For example, we risk reducing the time and resources available to those who desperately need professional help if the system is clogged up with inappropriate referrals and arguably overdiagnosed conditions.

Finally, there is a danger of confusing public opinion if the true horrors and tragedy of serious psychotic illness are relativised and given the same mental health moniker as unpleasant but mundane psychological challenges.

National Insurance Contributions: Healthcare

Baroness Fox of Buckley Excerpts

Tuesday 19th November 2024 Lords Chamber

[Baroness Merron (Lab)]

I certainly agree with the comments of my noble friend Lady Taylor, who set out the government response very clearly in the last Question. I also share the view of my noble friend Lord Foulkes that it is important to be honest; I believe we have taken that on board as a new Government. That is why, for example, we commissioned the independent review by the noble Lord, Lord Darzi, to find out the state of the NHS in order that we could move forward. What the noble Lord found did not make for pretty reading, and it is our job to put this mess into a rather better shape than it is now.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, what has been described as “groans” might, in another language, be described as holding a Government to account. The Government are in charge now and have to answer the charges as put.

If the Minister is correct that the Treasury evaluated what the changes to employers’ national insurance contributions would be, the Government will have known that this was going to affect not just big nasty bosses but a wide range of employers—hospices, care homes and all sorts of charities. The hairdressing sector is being decimated as we speak. I just went and stood in the rain for two hours at the farmers’ demonstration, where tenant farmers pointed out that these national insurance changes will mean they will have to sack farm workers. This is having a wide decimating impact. If the Government are going to be honest, I hope they will talk to each and every one of the sectors and tell them that this is going to be resolved one way or another.

[Baroness Merron (Lab)]

This Government are very committed and are indeed talking to all sectors, including in my own department. As to the point the noble Baroness rightly raises about holding Governments to account, I welcome that. It gives me and my noble friends an opportunity to set out the plans, responsibilities and concerns of this Government. We will take them seriously and continue to work to get consensus wherever we can.

NHS England: Ovarian Cancer

Baroness Fox of Buckley Excerpts

Thursday 2nd May 2024 Lords Chamber

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I welcome the untangling of linguistic confusion and the implications for policy. However, when the Minister says, “When we say ‘woman’, we all know what we mean”, I am not convinced that that is true in policy circles. Increasingly, inclusive linguistic demands are that “women” includes men who self-identify as women, which means that by-women and for-women provision, such as rape crisis centres, domestic abuse support and so on, is actually not women-only at all. When the Minister says, “We all know what we mean by ‘woman’”, can he make it absolutely clear that he means “woman” as in “natal woman” and not those who identify as women?

[Lord Markham (Con)]

I guess what I am trying to say here—again, always with my health hat firmly on—is that I want to make sure that when we describe something in a health sense, I want that person to know that we mean them because we are doing something which applies to them, often in the case of ovarian or cervical cancer. By saying “woman”, obviously in most cases that will make it very clear that it applies to them—particularly to those with English as a second language—and they know what that means. To make sure we are covering all the bases, I am very happy that we have that secondary descriptor of a “person with ovaries”. I am trying to cover all the bases in an inclusive way so that the health message gets through.

Anaesthesia Associates and Physician Associates Order 2024

Baroness Fox of Buckley Excerpts

Monday 26th February 2024 Lords Chamber

[Lord Patel (CB)]

I hope they do find time, because that allows for better scrutiny and better ability to amend, which we always claim to be our key role—to scrutinise and amend. It is a major piece of legislation to go through using SIs, and it is inappropriate to do so. Maybe we must consider how else we could do it in a way that maintains flexibility.

Moving on from that, as the noble Lord, Lord Harris, already mentioned, if this legislation is going to be the template for future legislation to regulate all health professionals, some issues will need to be discussed. This order does not require that health is considered as a category in the regulation of physician and anaesthesia associates. The statistics show that, when the GMC or, I presume, any other regulator investigates, it is a very stressful situation for the person involved. Some statistics suggest that one in three considers suicide; they are depressed by it. If the category of health is removed as a consideration when a person is investigated, as this order does, it is a backwards step. I need to ask the Minister why health has been removed as a consideration. If this is the template, I presume that this will also apply to other regulations in the future.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, the noble Lord, Lord Patel, just said many very important things, with which I agree, far better than I would. I thank the noble Baronesses, Lady Bennett, Lady Brinton and Lady Finlay, because this debate has revealed the importance of this order: it is not a minor regulatory matter that can be put through by an SI, in a back room. That it has created so much debate outside the Chamber indicates why it is important that we discuss this and that it is not nodded through behind the public’s back. I am glad of that.

I have been embroiled in discussions about this for some time. The noble Lord, Lord Hunt of Kings Heath, made a good point when he said that the discussion has become quite toxic. I thought it was perfectly reasonable to be worried about PAs and AAs; I did not anticipate this kind of savage attack on them. There has been a real scapegoating of these individuals, which is not how we should resolve this issue. We should also remember that doctors can be guilty of clinical negligence. We do not want to wander around pointing the finger at who is more negligent.

However, if there are preventable never events as a consequence of people not being fully equipped for the roles that they are asked to do—by the way, they are being asked, very often told, what to do when they are not really up to it, through no fault of their own—it is a matter for public concern. That is the way that accountability works and why we need to be very clear and have no muddle over what somebody is supposed to be doing, what they are not supposed to be doing, and what they can and cannot do.

There were a couple of things that confused me in the arguments made in the briefings we received. I lost the will to live in the rows going on about the differences between physician associates and physician assistants, as though “associate” or “assistant” was the key difference. I think the difficulty is when people think that any of them are physicians, because that means that they think they are doctors. That is the confusing bit and it shows that people can get lost in the midst of this.

It is also worth bearing in mind some context when it comes to the public. Most patients would prefer to see anyone at a doctor’s practice than wait for two weeks in pain. That makes the public vulnerable to having a lesser service. I understand that. I also thought that the noble Lord, Lord Patel, was absolutely right about a big team: when you are in hospital, you are surrounded by people wearing a million badges, different colours and lanyards. They all introduce themselves to you in great detail, but you do not care because you are ill. You want to lie back and trust them, and assume that a division of labour is going on.

Sometimes, when I was reading the briefings, it felt as though there might be a bit of vested interest about who was regulating who and what numbers were on the badges. This seemed to miss the point of the real concerns, which are whether there is sufficient clarity about the scope of PAs or AAs, or whatever we call them; that there is not too much mission creep; and that we have a clearly defined set of protocols and specific tasks allocated. I think it important that PAs in GP surgeries have a different set of protocols and scope than in hospitals—they are not the same, even though in both instances they are called PAs.

Covid Pandemic: Testing of Care Home Residents

Baroness Fox of Buckley Excerpts

Monday 6th March 2023 Lords Chamber

[Baroness Fox of Buckley (Non-Afl)]

My Lords, what is so devastating in reading the Telegraph’s WhatsApp lockdown file is that it has confirmed that the most susceptible to Covid were victims of a lack of targeted testing in care homes, while the least at risk were hectored and frightened into getting tested to reach one government Minister’s self-set arbitrary targets. Will the Minister take back that we urgently need this public inquiry? Will it scrutinise the process of target-setting that lost sight of its original aim? Also, after the revelations that Minister Helen Whately raised concerns about the inhumane policies of separating people in care from their families—so lonely and distraught that they gave up—will the Minister support the Rights for Residents campaign to enshrine in law the right to maintain family contact in all care settings? It was not just the lack of testing that killed people but some of the policies too.

[Lord Markham (Con)]

We all agree that visiting should be allowed as much as possible. I know that the policy is that people can receive at least one visitor, but I know that there are also examples where that is not happening enough. It is very clear, from our side, that it is a priority that everyone should have visitation rights, because they are vital. Can we say that that will always be the case in every circumstance in the future? Well, clearly no one foresaw the pandemic, so this is one of those situations where we can never say so definitively, but we all firmly agree that visitation is a key part of people’s care and well-being.

NHS: Access to Treatments

Baroness Fox of Buckley Excerpts

Wednesday 7th September 2022 Lords Chamber

[Lord Kamall (Con)]

A number of noble Lords have already asked that question. I will take it back to department and get an answer.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, could I ask the Minister to read and circulate an article from Saturday’s Guardian by Merope Mills, a devastating account of the preventable death of the journalist’s 14 year-old daughter, Martha? Would the Minister note that Ms Mills, an erstwhile, uncritical NHS cheerleader, stressed that this

“had nothing to do with insufficient resources or overstretched doctors and nurses … austerity or cuts, or a health service under strain”?

Can the Government recognise that this crisis goes far deeper than simply listing numbers, money or technical solutions?

[Lord Kamall (Con)]

The noble Baroness is absolutely right that it is not just about money, although money does play an important role; it is also about processes and efficiency. In my conversations with people who have been in the NHS or medical services for years, many have commented that we still have the same old model: you go to see a GP, you hope to see them for five or 10 minutes and then you are referred to someone in secondary care. There is a much more efficient way of doing that in this day and age. We have to look at the whole model of both health and social care and modernise it.

Coronavirus: New Cases

Baroness Fox of Buckley Excerpts

Monday 11th July 2022 Lords Chamber

[Lord Kamall (Con)]

We rely on data from the UK Health Security Agency. It monitors this, and looks at ONS data, data on hospitalisations and the capacity of the NHS to absorb the increase in patient numbers if there is one. That is where we take our advice from and that is what would trigger future action, should it be needed.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I confirm that there is anxiety about the rise in Covid cases, but less about the virus itself than a worry that politicians might reintroduce some of the over-the-top restrictions that led to such collateral damage during the past two years. Hindsight or not, I make the point that people are nervous. Very specifically, will the Minister comment on the fact that, for example, some care homes are using the rise in Covid cases to lock down homes and carry on restricting visits with relatives—which we now know is damaging the mental and physical health of so many elderly care home residents, who suffered so inhumanely, not from Covid but from our response to it? Will he encourage those care homes to open up and be a bit more confident?

[Lord Kamall (Con)]

I start by paying tribute to the noble Baroness for her championing of civil liberties issues and making sure there was a debate on them. I will, with pleasure, take back her point on care homes to my ministerial colleagues who are in charge of social care.