Mental Health Bill [HL]

Baroness Merron Excerpts

Wednesday 2nd April 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, I thank the noble Baroness, Lady Tyler, for, as others have said, the eloquent way in which she introduced her amendment.

I know this is a topic that noble Lords across the House feel strongly about, and I appreciate the arguments in favour of the creation of a commissioner. Indeed, as other noble Lords have said, it was a recommendation of the pre-legislative Joint Committee.

Having listened keenly to what the noble Baroness has said, and having discussed this issue with her and her noble friends, I have to say that I agree with the noble Lord, Lord Bradley, when he says that the landscape has changed. We are now at a time when the Government are looking to reduce duplication and arm’s-length bodies—something that I believe a responsible Opposition should support. We believe it should not be necessary to have a new, separate, independent mental health commissioner.

We were going to group this amendment with the ideas about strengthening the CQC, but that has been ungrouped and we will talk more to it in the next group. When I had some conversations with those who supported the independent mental health commissioner, they said I should look to Children’s Commissioner as an example. I looked at the Children’s Commissioner; it does a great job, but it has a staff of 25, a temporary staff of 31, and expenditure of £3 million. That may not sound a lot of money but I wonder whether that amount of money could be better invested in strengthening the CQC. One of the things about any bureaucracy is that they grow and have more non-essential roles as other bits of legislation bring them in. I worry about the cost and duplication of functions.

I completely understand the argument from those who say that the CQC has not been doing its job and those who have criticised it for being ill-equipped. That is why we tabled our amendment, which will be discussed in the next group, about strengthening CQC functions. However, rather than saying all that now and repeat it in the next group, I do not wish to detain the House any longer. I believe there should be a comprehensive review of the CQC and proper accountability, and I hope we can achieve that without an independent commissioner.

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

My Lords, I thank all noble Lords for their contributions on this fiercely and keenly debated proposal. Amendment 47, in the name of the noble Baroness, Lady Tyler, leads me to say that we continue to be of the strong view that the functions of the proposed commissioner, as set out in the amendment, would clearly overlap with the existing responsibilities of other organisations, most notably the CQC. I must respectfully disagree with the noble Baroness: the CQC has a statutory role in monitoring the Mental Health Act. It publishes an annual report that serves to drive policy improvements in this area.

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[Lord Scriven (LD)]

Can I just ask the noble Baroness a very quick question? Will the newly appointed person have a statutory right to call for papers and witnesses from other departments to deal with mental health issues, as a commissioner would?

[Baroness Merron (Lab)]

I cannot draw a comparison with a commissioner but I will be very pleased to answer the noble Lord definitively in writing.

Secondly, as announced by the Secretary of State, we are abolishing NHS England as part of the radical reforms we are making to the national health system to rid it of duplication, inefficiency and waste, so that vital resources can be redirected to the front line. On this, we very much look forward to the much-anticipated report from Dr Penny Dash on the wider patient safety and oversight landscape. Of course, as noble Lords will be aware, the 10-year plan for the NHS is being co-developed with staff, patients and the public. I believe these changes only confirm that creating a new mental health commissioner would be not only duplicative but completely at odds with the important and very live reforms that the Government and the CQC are making.

During the course of the Bill, including today, I have heard noble Lords speak passionately about introducing a mental health commissioner role akin to that of the Children’s Commissioner. I very much value the work of the Children’s Commissioner and, as I have said before, I do not accept that it is a valid comparison. More pressingly, following a constructive meeting last week with the Children’s Commissioner, which the noble Baroness, Lady Tyler, referred to, I can report that she is concerned about the establishment of a mental health commissioner. In her view, covering all aspects of children and childhood is a critical part of her role. This is because children see their mental health as indistinguishable from their wider health and experience of childhood. We discussed this at some length. The Children’s Commissioner’s view is that the proposed establishment of a mental health commissioner risks taking a siloed approach to the barriers and challenges that children face, and I feel it is incumbent on us to listen to that view.

I also reiterate that I am deeply concerned about the level of resource needed to take this forward, as required in the amendment, as was understood by the noble Lord, Lord Kamall. This would be on top of the resources needed to remodel the healthcare quality and regulatory landscape to avoid the risk of duplication and waste. I can honestly say that I do not feel that this can be justified, particularly in the current climate.

The noble Baroness, Lady Bennett, made comparisons with the Government’s plan to introduce an Armed Forces commissioner. This is a manifesto commitment that we are certain addresses an important and specific gap: the strengthening of support for Armed Forces communities to improve service life. Furthermore, we are talking about an entirely different set of responsibilities, aimed at different set of needs in an entirely different environment. So I have to say once again that I do not believe that it is a useful comparison with respect to Amendment 47. For these reasons, I ask the noble Baroness to withdraw the amendment.

[Baroness Tyler of Enfield (LD)]

My Lords, I thank the Minister for her response and particularly thank other noble Lords who have contributed. I apologise to the noble Baroness, Lady Bennett, for forgetting to thank her for adding her name.

The short answer is that we disagree quite fundamentally on this. I do not accept the argument that the Minister has just put forward that the comparisons that I and the noble Baroness, Lady Bennett, have drawn are not good; I think they are very good. Of course, I understand that the landscape has changed. I understand that arm’s-length bodies, particularly large ones, have gone out of fashion and I understand the reason for that. I am talking about a very small body that acts as an advocate. I think that is different. I do not think it is something that the CQC can or will do.

I am pondering on what the Children’s Commissioner has said. I understand the point about children and their mental health being part of their wider experience, but we have to remember that a lot of the work of the mental health commissioner would be about adults who are being detained and whatever. We are not going to agree, so I suspect the best thing to do is to test the opinion of the House.

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[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.

[Baroness Merron (Lab)]

My Lords, I thank all noble Lords for their contributions on this important and somewhat wide-ranging group of amendments.

I turn first to Amendment 48, tabled by the noble Baroness, Lady Tyler. We very much recognise that there are inequalities in the use of the Act between different demographic groups, and particularly that there are significant racial disparities. The noble Lord, Lord Kamall, has rightly expressed some frustration with the fact that we all find ourselves where we are today.

To those points, I would say that these inequalities are explored in the impact assessment published alongside the Bill. I reiterate how grateful I am to Peers who recently attended our round table to examine research findings and ongoing work to address racial disparities under the Act. I am glad to hear that the noble Baroness, Lady Tyler, found it helpful—as indeed I did.

I offer the assurance that NHS England already publishes the Mental Health Act Statistics annual reports, broken down by ethnicity and other demographic information, including gender, age and index of multiple deprivation decile. We are improving the data through the patient and carer race equality framework, and we will monitor these inequalities as part of the overall monitoring and evaluation of the reforms.

Furthermore, as I announced on day one of Report, I commit to update Parliament annually on our progress with implementation, including racial disparities. I also committed to undertake further investigation into racial inequalities under the Act. As far as possible, we want to better understand where disparities are most significant across the patient journey, what drives those disparities and, most importantly, where we can most effectively intervene to reduce those inequalities. I very much look forward to keeping Peers updated on those findings, as the noble Lord, Lord Kamall, has rightly requested.

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[Lord Kamall (Con)]

I am sorry to interrupt. Just to go back to my amendment on the CQC, one of the arguments for those who believed in creating an independent mental health commissioner was that they would be a voice for the patients. With that strengthened role for the CQC, where is that voice for the patients? That was one of the justifications for those arguing for creating a mental health commissioner. We decided not to support that because we thought that function should be part of what the CQC does. Could the Minister reassure us on that point?

[Baroness Merron (Lab)]

For me, it is about not just somebody speaking for others but getting those voices heard. I hope that the noble Lord and all noble Lords have heard my acknowledgement of the importance of that. Those with lived experience need to be properly heard and their voice amplified. I have given a number of reassurances on that point.

With that, I hope that the noble Baroness can withdraw her amendment.

[Baroness Tyler of Enfield (LD)]

My Lords, I thank all noble Lords who have contributed to this group and the Minister for her responses. I also thank the noble Lord, Lord Kamall, for supporting my suggestion about a pilot for the responsible person. I have noted that the Minister has said that a pilot is not really necessary because what the Government are doing goes further than that. That is one way of looking at it, but I have to be honest and say that it is not quite how I see it. I completely take the point that we need to see what happens when the PCREF has bedded down. Let us see what it achieves, but if it does not achieve what we all want to see then we will need to think at that point about whether a responsible person would make the sort of difference that was being talked about at that very helpful round table.

I look forward to hearing more about the various actions that the Minister mentioned in relation to the CQC. I of course look forward to meeting the new chief inspector and will be interested to hear how they see their role, particularly the extent to which they think they are an advocate, providing a voice for people with mental health difficulties. This gets to the very heart of this Bill and the very reason why we have it in the first place. It is an incredibly important issue. We could talk about it for a long time, but we cannot. The hour is late and it is incredibly unfortunate that we have had such a truncated second day of debate. I know that these things happen but, given the importance of the topic, it is extremely unfortunate. Having said that, I beg leave to withdraw my amendment.

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The noble Lord is right to focus our minds on the recently published and very troubling announcement on mental health spending. I therefore hope that the Minister will be able to deliver, at the Dispatch Box, some robust assurances on mental health spending, as well as on parity of esteem more generally, which will obviate the need for the noble Lord to press his amendment and will satisfy honour on all sides.

[Baroness Merron (Lab)]

My Lords, I am grateful for all the contributions and considerations this evening, to which I have listened closely.

I first turn to Amendment 50 in the name of the noble Baroness, Lady Tyler. Workforce is absolutely a critical factor in enabling these reforms and we have committed to recruiting 8,500 more mental health staff over the course of this Parliament. The impact assessment sets out our expectations for the additional workforce that is required to deliver the Bill.

However, there are already various mechanisms in place to monitor and address concerns about the mental health workforce. The amendment would be duplicative and unnecessary. Providers registered with the CQC—both NHS and independent services—are required to deploy enough suitably qualified, competent and experienced staff, as outlined in Regulation 18 of the Staffing of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. If CQC finds a breach in Regulation 18, it can take action.

The Mental Health Act Code of Practice also states that local authorities should ensure that there are sufficient approved mental health professionals and independent mental health advocates. All staff in CQC-registered providers must receive the appropriate training that is necessary to enable them to carry out their duties under Regulation 18 of the Health and Social Care Act Regulations 2014.

At a national level, CQC reports on workforce sufficiency as part of its monitoring of the Mental Health Act report. We would argue that this is a much better process than requiring integrated care boards to mark themselves on how well they are fulfilling their duties.

Furthermore, as I said on Monday and wish to reiterate, we are committed to laying an annual report on implementation, which will set out progress made and future plans for implementation. This will include information on the expansion of the workforce, including second opinion appointed doctors, Section 12 doctors and approved clinicians. It will also include details of the key statistics and outcomes under the Mental Health Act, including detention rates, community treatment order rates and other key metrics, such as racial disparities and outcomes for children and young people, all of which noble Lords rightly seek. I hope this annual commitment will be welcomed by your Lordships’ House and that this, combined with the existing workforce monitoring I have referred to, will allow the noble Baroness to withdraw her amendment.

On Amendment 59, I also understand —as does the noble Earl, Lord Howe—the intention of the noble Lord, Lord Stevens, which is to ensure that we invest in delivering these reforms. I want to be clear: as I said in Committee, there are already mechanisms in the NHS Act to prioritise mental health spend to deliver these reforms.

To reiterate the point that I made previously, we believe that this amendment is not the right mechanism to ensure that we do that. I will return to the three main reasons for that, but I want first to refer to the point the noble Lord, Lord Stevens, made when he spoke of “shrinking mental health spend”.

[Lord Stevens of Birmingham (CB)]

It was the shrinking share of mental health spend.

[Baroness Merron (Lab)]

I thank the noble Lord for that correction from a sedentary position. Perhaps I could provide some more clarity, which the noble Earl, Lord Howe, also asked for.

The proportion of spend is almost exactly the same as it was last year, with a difference of just 0.07%. We understand concerns that the share of overall NHS funding for mental health will reduce slightly. However, this does not mean that mental health funding is being cut, and I would not want noble Lords to think that to be the case. To be clear, spending on mental health support will increase relative to 2024-25 and is forecast to amount to £15.6 billion—an increase of £680 million in cash terms, and equivalent to £320 million in real terms.

Perhaps it would be helpful for me to return to the three main reasons for not supporting this amendment. The first is—as the noble Earl, Lord Howe, helpfully referred to—what I would call a point of principle. Primary legislation should not be used to constrain spending in this way. Multiyear budgets for government departments will be set by the established spending review process, which considers spending in the round and in the context of the Government’s policy priorities. Additionally, it is Parliament that is responsible for scrutinising government spending and approving spending set by departments for the current financial year as part of the estimates process.

Secondly, the amendment as drafted applies only to spend under the Mental Health Act. The mental health system, as noble Lords will appreciate, does not structure its accounts based on the legal framework under which a patient is held. A single ward, for example, could contain a mix of patients under the Mental Health Act and informal patients who would not usually be considered to be under the Mental Health Act. Likewise, community services will support a mix of people, some on community treatment orders and others who are not. It would be impractical to require services to split costs based on the ever-changing patient mix within their care.

The third reason for not accepting this amendment, and perhaps the most fundamental point, is that the share of spend on the Mental Health Act could reduce over time, which is not undesirable. I will explain why. The genesis of these reforms is the review initiated by the noble Baroness, Lady May, to address the rising rates of detention. We all want to see more people cared for effectively in the community so that the need for the use of the Act is reduced. This would require more investment in preventive community services, which, I put to noble Lords, is surely the preferable model for supporting severe mental illness. In creating a legal requirement for the share of spend specifically under the Mental Health Act not to decrease, this amendment would actually preclude the shift from detention to prevention that I know we all want to see.

So, while I absolutely understand the intention, and I can commit that we will invest to deliver these reforms, we cannot support this amendment, which, for the reasons I have outlined, we believe is fundamentally flawed. For these reasons, I hope that the noble Baroness will withdraw her amendment and the noble Lord will not press his.

[Baroness Tyler of Enfield (LD)]

My Lords, this has been another incredibly important group of amendments. We are very short of time. I thank everyone who has contributed. I welcome that the Minister has committed to an annual report on implementation. I hope that there will be an opportunity for a debate in both Houses when that annual report is received. I was very grateful to the noble Earl, Lord Howe, for his support on my Amendment 50, which I will not be pushing to a vote. I do not consider it to be duplicative and unnecessary. If I did, I would not have tabled it. I thought that it was quite good, but I am not pushing it to a vote.

My final comment is that I was very pleased that there was widespread support for the very important amendment tabled by the noble Lord, Lord Stevens. It was variously described as modest, elegant, clever and other things. It had an awful lot going for it, but I leave it to the noble Lord, Lord Stevens, to say how he wishes to proceed. I beg leave to withdraw my amendment.

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[Lord Kamall (Con)]

My Lords, this will probably be the last time I speak on Report—and I am sure many people are grateful for that. Before I make my last remarks, I want to put on record my gratitude to the Minister, her officials and the Whips for the amount of time they have given us in discussing a lot of these amendments. It is certainly appreciated by our side and, I am sure, by other noble Lords.

Given the time, I will not take another hour. The sentiment behind this amendment is unquestionable. During my time as Minister, I was repeatedly reminded of the need to focus on prevention, and of course I agreed to that. As we know, the noble Lord, Lord Darzi, in his report on the state of the NHS, repeated his emphasis on the shift to prevention. If we believe in parity of esteem, where possible, this should be applied to mental health.

If we can shift from a situation where we are treating patients and repeatedly detaining them, such that they are detained for longer, to a scenario where we can treat and prevent those conditions worsening, our mental health system will be better for it. I am sure that all noble Lords can agree with this. So we strongly agree with the intent here, which is in line with one of the Government’s other intentions: a shift from hospital to community.

However, when I have discussed this amendment with others, I have heard one concern that I am still reflecting on. This amendment states that ICBs, local health boards and local authorities must implement preventive policies. It has been suggested to me that this might be too prescriptive or may place a duty on smaller bodies that may not necessarily have the resources to implement such policies. Those who suggest this tell me that it may appear more reasonable to place that duty on the Secretary of State or the Department of Health and Social Care, which have the capabilities and resources to implement preventive measures. Such a policy could work if the department had to work with ICBs and local authorities, as well as local community non-state civil society organisations, to move towards preventive care. As I said, I am still reflecting on this, but I do not wish to detain the House while I make up my mind. So, with that, I look forward to the response from the Minister.

[Baroness Merron (Lab)]

My Lords, I thank all noble Lords for their contributions on Amendment 63A in the name of the noble Baroness, Lady Bennett. I am grateful for the appreciation of the noble Lord, Lord Kamall —and the appreciation shown throughout Report—for the whole team. Similarly, I reciprocate thanks to all noble Lords and their offices for their assistance in improving the Mental Health Bill.

As the noble Baroness observed, we agree with the intention of the amendment: there must be a focus on prevention and the commissioning of services must reflect the needs of the local community. However, we do not feel that it is necessary to place this requirement in statute. As the noble Baroness knows, the Government are currently co-developing the 10-year health plan with the public, staff and patients. As part of this, we are exploring ways to stimulate the shift from sickness to prevention so that we can deliver an NHS fit for the future.

I turn to the points raised by the noble Lord, Lord Scriven. First, progress is already being made to transform community mental health services. In the last 12 months, more than 400,000 adults have received help through new models of care that aim to give people with severe mental illness greater choice and control over their care. We are going further by piloting the 24/7 neighbourhood mental health centre model in England, building on learning from international exemplars such as those in Trieste, which I know the noble Baroness, Lady Bennett, has taken a great interest in. Six early implementers are bringing together their community, crisis and in-patient functions into one open-access neighbourhood team that is available 24 hours a day, seven days a week. This means that people with mental health needs can walk in or self-refer, as can their loved ones.

ICBs are already required to have policies that reflect their communities under the National Health Service Act 2006, as amended by the Health and Care Act 2022. Section 3(1)(i) of the NHS Act 2006 also specifies the duty of an ICB to commission certain health services, including

“such other services or facilities for the prevention of illness”.

An integrated care board must arrange for the provision of services

“to such extent as it considers necessary to meet the reasonable requirements of the people for whom it has responsibility”.

ICBs and their partner NHS trusts and foundation trusts, including their mental health trusts, are also required to prepare a joint forward plan, which describes how the ICB will arrange for NHS services to meet their population’s physical and mental health needs.

Given that these duties already exist, given the Government’s commitment to a shift from sickness to prevention, and given the progress being made on community transformation and expansion of crisis services, we do not consider that it is necessary to create any additional duties within the Mental Health Act and I hope the noble Baroness will feel able to withdraw her amendment.

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Moved by

[Baroness Merron]

64: Clause 52, page 64, line 23, at end insert—
“(3A) A statutory instrument containing (alone or with other provision) regulations under this section that amend or repeal provision made by primary legislation may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.(3B) Any other statutory instrument containing regulations under this section is subject to annulment in pursuance of a resolution of either House of Parliament.”Member’s explanatory statement
This amendment and my other amendments to clauses 52 and 53 would ensure that regulations made under the consequential amendment powers in the Bill that amend or repeal primary legislation are subject to the affirmative resolution procedure.

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Moved by

[Baroness Merron]

66: Clause 53, page 65, line 1, at end insert—
“(4A) A statutory instrument containing (alone or with other provision) regulations under this section that amend or repeal provision made by primary legislation may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, Senedd Cymru.(4B) Any other statutory instrument containing regulations under this section is subject to annulment in pursuance of a resolution of Senedd Cymru.”Member’s explanatory statement
See the explanatory statement for amendment 64.

Mental Health Bill [HL]

Baroness Merron Excerpts

Report stage
Monday 31st March 2025 Lords Chamber

Amendment 56, from the noble Baroness, Lady Hollins, seems sensible to us. The Government have some explaining to do as to how they are planning to ensure greater safeguards for those subject to long-term segregation. If the noble Baroness, Lady Hollins, is not satisfied by the Minister’s response, when Amendment 56 is called we may be minded to support her. With that, we look forward to the Minister’s comments.

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

My Lords, I start by saying how grateful I am to noble Lords for their amendments and for the contributions they have made today. I express my thanks at the beginning of this first day of Report for the generosity of time and expertise of noble Lords from across the House—I have greatly appreciated it.

I turn now to the specifics. As the noble Baroness, Lady Browning, is aware, I agree with the principle behind Amendment 1, but there are limited circumstances where it might be appropriate to use the Mental Capacity Act to ensure that patients get the right support. I am glad that the noble Baroness welcomed my letter and that it was helpful. For people who have recently received treatment for a psychiatric disorder under the Mental Health Act, the Mental Capacity Act may be required to continue to support the individual in hospital in the short term while a community-based placement is being arranged.

Monitoring our reforms will indeed be crucial, as many noble Lords have said today. The NHS England assuring transformation dataset collects data on the number of people with a learning disability and autistic people detained in mental health in-patient settings under the Mental Capacity Act. As the noble Baroness herself referred to, the current number is fewer than five; nevertheless, it is, as she said, important.

I reiterate from this Dispatch Box the commitment that I made in the letter. Ahead of reforms to Part II, Section 3, we commit to monitoring the number of people with a learning disability and autistic people who are detained under the Mental Capacity Act, and will include a line on this in standard publications. Should we see an increase in this number following the reforms and discover that the Mental Capacity Act is being used inappropriately, we will ensure that appropriate action is taken.

I thank the noble Baroness, Lady Hollins, for her work on long-term segregation. Many noble Lords have raised facilities and community resourcing. I will address this, and the concerns about commitments in this Act being applied, when I turn to Amendments 4 to 6. On Amendments 3 and 55, there is a requirement in the Mental Health Units (Use of Force) Act 2018 to publish instances of isolation in mental health units. We have consulted on making this and other restrictive practices notifiable to the CQC within 72 hours for all patients in mental health hospitals, allowing the regulator to take prompt appropriate action.

Practical concerns were raised through the consultation that was held, which we are legally required to consider. I hope noble Lords will understand that because of this I am unable to commit to mandating reporting at this stage or to give a timeline, which I was asked for. However, noble Lords can be well assured that I more than understand the urgency. My officials have written to the CQC to commission it to develop a proportionate reporting mechanism, as has been referred to, and these changes can be made in regulations.

The noble Baroness, Lady Hollins, asked about restricted practice notification. Because this is to be made in regulations, clearly that will be, as usual, when parliamentary time allows. Every NHS-funded organisation is responsible for ensuring that safeguarding duties are applied. The code of practice requires the local safeguarding team to be made aware of any patient in long-term segregation.

On Amendment 56, the code of practice already sets out that a patient’s situation should be reviewed by a clinician at least once every 24 hours and at least weekly by the multidisciplinary team. The CQC has received funding to continue the programme of independent care or care (education) and treatment reviews for two years, and reviews recommenced in May 2024. We need to consider the programme’s impacts and the outcome of the spending review before future decisions are taken. Doing this outside legislation allows for flexibility. The independent care (education) and treatment reviews model has evolved as we have learned about what works best. We want to be able to continue to deliver the right approach. On Amendment 52, we will review the guidance in the code of practice on the use of long-term segregation, drawing on available evidence. This does not require primary legislation.

To my point on drawing on available evidence, we will indeed use the report of the noble Baroness, Lady Hollins, alongside other evidence, to consider changes that need to be made to the Mental Health Act code of practice, which we will review as part of the implementation of the Mental Health Act reforms after Royal Assent. We hope that this, alongside other actions that we are taking—including the continuation of ICETRs and NHS England’s quality transformation programme—will make progress to reduce long-term segregation.

There were points raised about Amendment 53, which we will return to in the debate on the fifth group. On Amendment 57, it is our belief that this duplicates existing requirements. The Mental Health Units (Use of Force) Act 2018, once fully implemented, will require mental health units to have a responsible person who must keep a record of any use of force by staff.

I absolutely understand the concerns that many noble Lords have raised about community support. This has driven Amendments 4 to 6. I also recognise the need for accountability and scrutiny of these reforms—a point that has been made several times.

I say to the noble Lord, Lord Scriven, that I hope I am about to do better by him than, “It will be all right on the night”, but he will be able to judge that. I am pleased with what I can commit, which is that within a year of Royal Assent, and each year subsequently, we will lay a Written Ministerial Statement in both Houses. This will include setting out details of the work that has been done over the preceding 12 months to implement this legislation and plans for how we will implement future reforms. It will include progress on the learning disability and autism reforms and plans for community provision.

Regarding Amendment 68 and the remarks by the noble Lord, Lord Crisp, we have heard concerns about possible unintended consequences, such as the potential criminalisation of individuals or detention via other legislative routes. To avoid such scenarios, we will commence changes to Section 3 only once there are strong community services in place and it is safe to do so, because flexibility is essential.

I hope that these commitments will satisfy noble Lords not to press their amendments.

[Baroness Hollins (CB)]

Will parliamentarians be able to question and amend the plan that will be laid before Parliament every year? The lack of ability to influence that process and that plan concerns noble Lords.

[Baroness Merron (Lab)]

I have heard from noble Lords that they are concerned with having transparency, holding the Government to account and being updated on the situation. I absolutely agree with all those points, which is why I am pleased to make that commitment. Parliament has a number of routes available to it to hold the Government to account. I have just outlined the manner in which we will be transparent and the way the Government will be held to account by having to do that. As always, parliamentarians have the ability to scrutinise in many ways.

[Baroness Browning (Con)]

My Lords, we have heard a lot of very salient and not just helpful but wise words in the debate on this group of amendments. I thank the Minister for standing at the Dispatch Box and making commitments that are now on the record with this Bill. When people ask what Parliament’s intention was, she has left us in no doubt on some important points, particularly on my amendment concerning the need to monitor the use of the Mental Capacity Act in respect of autistic people and people with learning disabilities. I am grateful that she has done that and for a similar commitment I think I heard her make around some of the concerns that the noble Baroness, Lady Hollins, had.

Finally, the Minister has not given us exact dates as to when implementation will take place. We imagine it may be staged—not all in one go—but before the end of this year, the committee upstairs will report on the post-legislative scrutiny of the Autism Act. That will cover a wide range of issues, particularly services to people with autism. I hope that, perhaps in her deliberations on this Bill, when she sees that report—I cannot predict what the outcome of that will be—she will take those into account as well. For certain, services provided under the Autism Act, if they are provided in a timely way, will reduce the number of services that will be needed under the Mental Health Act. It is not rocket science; it is pretty basic that if you provide those services, that downward spiral in mental health is reduced. With that, I beg leave to withdraw my amendment.

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[Earl Howe (Con)]

My Lords, this is Report and I do not propose to do more than underscore all that is been said by noble Lords who have spoken, particularly my noble friend Lady Berridge. Approved mental health professionals carry with them a huge responsibility for the well-being of those whose interests they are called upon to protect. When a child or young person suffers a mental health crisis, it is the job of the AMHP to make the right assessments, take the right decisions and follow the right procedures under the law to ensure that the young person is looked after appropriately and swiftly. To do that, he or she needs a clear set of ground rules to follow.

We need to imagine a situation, such as the one posited by my noble friend, in which a child’s mental and emotional condition is such that they lack decision-making competence. An AMHP is then called in. In that situation, when it comes to appointing a nominated person for the child, the scope for confusion and indeed delay is enormous. Who should be appointed? Is it the mother or the father, or is there someone else who should take precedence?

The Minister has acknowledged through the government amendments before us that, when there is a care order for the child, the AMHP should have no choice but to appoint the local authority as the nominated person for the child. That is a welcome step forward but, as my noble friend has rightly said, what if there is a special guardianship order or child arrangement order issued by the court under the terms of the Children Act? In those circumstances, too, the AMHP should be relieved of the obligation of making a decision that, if it is the wrong one, could leave them open to legal challenge. I very much hope the Minister will be receptive to the powerful arguments that my noble friend and the noble and learned Baroness, Lady Butler-Sloss, have advanced on these significant issues.

[Baroness Merron (Lab)]

My Lords, I thank all noble Lords for their contributions in this important area, and I thank the noble and learned Baroness, Lady Butler-Sloss, for Amendment 2.

On that point, I can say that a copy of the report made following a care and treatment review must be sent to those who have a legal duty to have regard to the review recommendations, so that they are implemented appropriately. We agree that parents play an important role. However, it may not be appropriate for the report to be sent to parents in every case: for example, where safeguarding concerns have been raised. Inappropriate sharing of information could result in the patient withdrawing their consent to the review. So we will provide statutory guidance on the role of the parent to assist the responsible commissioner in considering who to involve in care and treatment reviews.

On Amendment 25, also tabled by the noble and learned Baroness, Lady Butler-Sloss, the Bill already allows anyone involved in the patient’s care or welfare, which includes parents, to apply to the county court to terminate the appointment of a nominated person. I can assure the noble and learned Baroness that we will make this clear in the code of practice and the Explanatory Notes for the Bill, as she has raised an important point.

To address Amendment 27, we are concerned that making it a requirement for parents always to be consulted when a nominated person is chosen could put undue pressure on a child to choose a parent. However, we agree that the witness should consider the views of parents and others who may have insight into the suitability of a nomination. I can tell the House that we will therefore set out in the statutory code of practice how the views of the family and others should be fed into the witnessing process.

I have also heard the concern of the noble Baroness, Lady Berridge, about the nominated person regarding children who lack competence. In response to this, as she acknowledged, I have tabled Amendments 29 to 33 to make it clear who an approved mental health professional must appoint in certain circumstances. For an over-18 lacking capacity, an approved mental health professional must appoint a competent lasting power of attorney or Court of Protection deputy, if they have one. For all under-18s lacking capacity or competence, where there is a care order, they must appoint a local authority which has parental responsibility for them or, if relevant, a competent Court of Protection deputy. Where there is no care order, the approved mental health professional can appoint a person who does not have parental responsibility for 16 and 17 year-olds. This allows for suitable alternative arrangements, for example, informal kinship arrangements for young people who live independently. I hope that this reassurance and commitment on my behalf provides the further clarity for which the noble Baroness has been advocating.

Finally, in response to Amendment 34, we agree that in the vast majority of cases we would expect a parent, or whoever has parental responsibility, to be appointed. This would include consideration of special guardians and child arrangement orders. As I have set out before, we do not agree that a person with residual parental responsibility should always be blocked from being a nominated person. A child arrangement order or special guardianship may be in place for reasons other than the parent being a risk to the child. For example, the parent might struggle with their own health issues but could still be an effective nominated person.

The situation is different in the case of a care order because the local authority is being given lead parental responsibility. We have engaged with the Children’s Commissioner on this point. As I believe the noble Baroness may be aware, I recently met the Children’s Commissioner on a range of issues, including discussions about the Mental Health Act.

If there are no relevant people, approved mental health professionals must follow the patient’s past and present wishes and feelings when deciding who to appoint. We do not believe that the eldest person should be given preference, as this represents an outdated assignment of responsibility. I assure the noble Baroness, Lady Berridge, that I have been advised that my officials met the chair—but I understand that the term is lead—of the AMHP Leads Network last November.

I can make a further commitment, which I hope will be helpful to your Lordships’ House. I am committing to establishing an expert taskforce to support the development of the statutory code of practice to provide clear guidance for professionals involved in the nominated person appointment process for children and young people. Views will be very much welcomed on who should be part of this; I have already invited the noble Baroness, Lady Berridge, and the noble and learned Baroness, Lady Butler-Sloss, to make suggestions about that. With these reasons, I hope that noble Lords can support our amendments and will not press their amendments.

[Baroness Berridge (Con)]

Before the Minister sits down, the information I have is that Dominic Marley of the AMHP Leads Network had not seen a draft of the Bill that was to go before Parliament. Can the Minister confirm that? The Minister has outlined that there can be an assessment of ill-health already before the courts. Is she confident in legislating when a group of professionals are saying that they are not competent to assess the illness or otherwise of that parent and that the matter, already determined by a court, needs to go back to a court to be re-evaluated? They say that they are not competent to do what you are asking of them.

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[Baroness Merron (Lab)]

I note what the noble Baroness has said. We have discussed these issues a number of times in the Chamber and outside. On her second point, the situation is as I have outlined, and I do not feel I should go further today. These are the points I wish to bring before your Lordships’ House. I am happy to take up the points she raised separately. However, on her point about the exact details of the meeting, to be quite honest I cannot give that level of detail. I am very happy to find out more from my officials. The noble Baroness originally asked whether there had been a meeting, and the answer is yes.

[Baroness Buscombe (Con)]

My Lords, the Minister will know that I pledged at the very beginning, before the Bill came to this House, that I would do all I could to help its passage. I made that pledge to the Secretary of State. Given the continued conflict, as we see it, with the Children Act, would the Minister be prepared between now and Third Reading—rather than us dividing the House on this later—to have a little more discussion on this issue? We discussed it at great length during our inquiry into the draft Mental Health Bill. To us, it is a significant point that does not appear to have been properly resolved. In wanting to support the Government in making sure, as my noble friend has said, that they are not opening themselves to legal challenge, and to ensure a safe passage of the Bill, can I put that possibility to the Minister?

[Baroness Merron (Lab)]

I am grateful to the noble Baroness, not least because she has also given me a bit of time to add to my earlier answer to the noble Baroness, Lady Berridge, about the meeting with the lead of the AMHP Leads Network last November. That meeting took place after the Bill was published.

On the point the noble Baroness raised, whether the House will be divided will be a matter for the noble Baroness, Lady Berridge, and others to decide, but I am always happy to have discussions. If the noble Baroness wishes to do that, I will be very pleased to, as always.

[Baroness Butler-Sloss (CB)]

I do not think I need to say anything else. I am relieved to hear from the Minister that it will be expressly in the code of practice. I am also grateful for the idea that I can put forward some suggestions, which would be very helpful. I do not propose to take any further steps on my three amendments, and I beg leave to withdraw the amendment.

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[Baroness Barker (LD)]

My Lords, like the noble Lord, Lord Davies of Brixton, I find myself in exactly the same place. We all know why the police have said that they are not the appropriate people to be first responders when somebody is having a mental health crisis and presenting a danger either to other people or to themselves. We also know that not putting anything in place, or not putting the right people in place, means that somebody having a crisis will not necessarily be seen by an appropriate person.

A number of us have looked at this and talked to people in the field, and we think that what will happen is that there will be a response from somebody on the front line in the National Health Service, either in an A&E department—because that is where a lot of people will go—or, more likely, from an ambulance. That will put the ambulance service under even greater strain and pressure than it is under now.

It is the hope of those of us who have been involved in the discussions so far—and the intent, I think, of the noble Baroness, Lady May, who is the prime mover behind this—that we do not do that. We should not wait until there is a terrible incident in which somebody is badly harmed; we must try to foresee that situation.

I suspect that, around the country, since the police have taken the decision that they have, front-line health services have had to come up with new ways of responding. The issue has not gone away; people are still going to have mental health crises in which they are a danger to themselves or seem to present a danger to others.

I propose that we follow the suggestion from the noble Lord, Lord Kamall, that there be further discussion on this—preferably with people from mental health organisations and from different parts of the NHS, as well as the police force—to see whether we can come up with something that will plug a very obvious gap.

As I have said before during the passage of this Bill, this is the last chance for the next 10 to 15 years to pass legislation on this subject. We need to behave diligently, take appropriate action now and not wait to rue the day in the future.

[Baroness Merron (Lab)]

I thank the noble Lord, Lord Kamall, for tabling these amendments. They seek to amend Section 2 of the Mental Health Act, which relates to admission for assessment, and Section 3, which relates to admission for treatment, as well as Section 5(4), which relates to detention for six hours pending application admission.

I emphasise that the police do not currently have the ability to detain under Sections 2, 3 and 5 of the Act. These amendments, as the noble Lord has referred to and as we discussed earlier, would give police additional powers, where they currently do not have powers to intervene. The noble Lord will be aware, and he mentioned the fact, that we do not support extending police powers in this way, and we understand that the police do not support an extension either.

I am very happy to continue discussion with the office of the noble Baroness, Lady May, as I have done previously. I know that my noble friend Lord Davies would also welcome a discussion, which I am very happy to commit to.

The noble Lord asked for amendments on Third Reading, but such amendments are to clarify any remaining uncertainties, to improve drafting and to enable the Government to fulfil undertakings given at earlier stages of the Bill. I am sure the noble Lord will understand that amendments are therefore restricted to technical points. For all those reasons, I cannot give the agreement that he sought on an amendment at Third Reading, as it is not within scope to do so.

With regards to the ambition to reduce police attendance at mental health incidents, we recognise the pressures that police are facing, which noble Lords have highlighted, and agree that, in many cases, it is far preferable for those in mental health crisis to be responded to by health and care professionals. However, action is already under way to address this. Almost all police forces in England and Wales are implementing the “right care, right person” approach—a police-led initiative to reduce inappropriate police involvement in cases where people have health or social care needs. There has already been a 10% decrease in Section 136 detentions last year. We are taking steps to improve mental health services to avoid people reaching a crisis where police involvement may be required in the first place, which is a far more preferable position to be in. That includes through the Government’s commitment of £26 million of capital investment to open new mental health crisis centres, which are far more suitable environments for those in mental health crisis to receive care and treatment.

Therefore, extending these legal powers currently held by the police to other professionals would represent a major shift in roles and responsibilities for health and care professionals. It would place significant additional pressures on the NHS and potentially lead to staff, patient and public safety issues which mental health and urgent and emergency care leads have already raised significant concerns about. It is for all these reasons that I ask the noble Lord, Lord Kamall, to withdraw his amendment.

[Lord Reid of Cardowan (Lab)]

My Lords, just before my noble friend sits down and before the noble Lord, Lord Kamall, has to reach his crucial decision on this amendment, perhaps I may clarify something. As I understood it, my noble friend the Minister said she was more than happy to respond to the invitation or proposal from the noble Lord, Lord Kamall, and various other colleagues to discuss the issue further, but she obviously could not commit herself in advance to bringing forward an amendment. Is that the position?

[Baroness Merron (Lab)]

It is indeed. The noble Lord, Lord Kamall, was very specific about bringing an amendment forward at Third Reading, and it was to that that I explained it was not possible to commit. I thank my noble friend for allowing me to reiterate that.

[Lord Kamall (Con)]

My Lords, I am grateful to the Minister for addressing the points that were raised, and I listened carefully to what she said. I had hoped that she would be open to resolving this issue, as I know she is with my noble friend Lady May. However, once again, there is a difference of opinion. As I understand it, amendments brought forward at Third Reading do not have to be only technical amendments and I had hoped that the Minister would give an undertaking to bring back an amendment at that stage. Given that we have a disagreement of interpretation on two issues, I am afraid I think it best to test the opinion—

[Baroness Merron (Lab)]

It might be helpful for your Lordships’ House to know that to fulfil what the noble Lord says, there would be a need for collective agreement to offer a commitment to bring forward an amendment at Third Reading, which I do not have. I emphasise the point made by my noble friend on this.

[Lord Kamall (Con)]

That is entirely understandable. I know the Minister always means well in our discussions and always tries to find a solution, but, given that, it may be helpful to finding a solution if I test the opinion of the House.

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[Baroness Merron (Lab)]

I thank the noble Lord, Lord Scriven, for tabling and speaking to Amendment 11, along with the noble Baroness, Lady Tyler. At the outset, I can say that it is already the case that community treatment orders can be renewed only under specific conditions, which aligns with the intent and direct requests of the noble Lord, Lord Scriven.

Alignment with the code and the four principles is already achieved by new Section 118(2D) of the Mental Health Act, which requires clinicians, before placing someone on a community treatment order, to have regard to the statement of principles in the code. Clause 6 ensures that a patient can be put on a community treatment order only if there is a risk of serious harm without it and a reasonable prospect of it having therapeutic benefit for the patient.

I assure your Lordships’ House that a responsible clinician cannot extend a community treatment order beyond six months, unless the conditions, including therapeutic benefit, continue to be met. A community treatment order can be extended for a further six months and then a subsequent 12 months, but only if these conditions continue to be met.

The current code of practice states that, before renewal, the responsible clinician should consult with the multidisciplinary team, the patient, the nearest relative—which in future will be the nominated person—and an advocate. I put it to the House that we are going further than the request from the noble Lord, Lord Scriven, by introducing a new requirement for the patient’s community clinician—who must be an approved clinician, overseeing the patient’s care as a community patient—to be consulted before a community treatment order is renewed beyond six months.

I have heard the concerns of the noble Lord, Lord Scriven, that the Bill requires just the second-opinion appointed doctor to be consulted, whereas the amendment requires the extension to be agreed with them. In response to that, I assure the noble Lord that, in addition, the community clinician must provide a statement that it appears to them that the community treatment order criteria continue to be satisfied.

We are increasing the frequency of automatic referrals to the tribunal to ensure that patients can come off community treatment orders when they are no longer benefiting them. The tribunal will have a power to recommend that the responsible clinician reconsiders whether a CTO condition is necessary. To elaborate further in view of the points raised, this means that, following an initial tribunal referral at six months, another referral is required after a further six months, followed by a mandatory referral 12 months after that, if the patient has not made an appeal themselves. The tribunal will have to agree the CTO criteria, including the requirement that a therapeutic benefit continues to be met. We are therefore already meeting the requests that the noble Lord, Lord Scriven, has rightly made and, in some places, going further than we have been asked to do.

I turn to Amendment 23, tabled by the noble Baroness, Lady Bennett. As I said on the similar amendment tabled by noble Lords on the Opposition Front Bench in Committee, CTOs remain a valuable intervention, albeit they need reform—as I more than acknowledge and accept. We will review these changes as part of our ongoing monitoring of the implementation and impact of the reforms. A review after two years would be premature, as it would be based on data from before any reforms were commenced. I say to the noble Baroness and your Lordships’ House that we will instead commit to review the impact our reforms have as part of our wider monitoring and evaluation of the Bill as it is implemented.

Amendment 62 is in the name of the noble Lord, Lord Kamall, and the noble Earl, Lord Howe. We are, as the noble Lord acknowledged, committed to addressing racial disparities under the Act—something I know the noble Baroness, Lady Tyler, was concerned about. I was very pleased to host a session a couple of weeks ago with leading academics, a number of officials from the department and Members of this House. We discussed in detail what is known and what further evidence is required. I give the assurance that work—as the noble Lord, Lord Kamall, has kindly acknowledged—is already under way, and we will continue to explore this issue. I am therefore happy to commit to undertake further investigation into racial inequalities under the Act.

The scope is to be developed further, but may involve synthesising findings of existing research, conducting a review of recent literature, and exploration of potential evidence gaps that require future research with experts and academics. Further research will receive sufficiently high-quality research applications and will be subject to the outcome of the spending review. I hope noble Lords will understand that we therefore prefer not to commit to a timescale in primary legislation but to allow time to develop and deliver research to ensure the best-quality evidence in this extremely important area. I hope noble Lords will not press their amendments.

[Lord Scriven (LD)]

I thank the Minister for that helpful explanation and description of community treatment orders. Despite all the words, whenever independent research is done, whether by the CQC, the Joint Committee or mental health organisations, the same answer keeps coming back. Something is fundamentally flawed, maybe not with the policy but with the implementation of CTOs. I note the Minister quoted the rule in the code of practice but, as we know, the code of practice does not necessarily have the legal status of something in the Bill. Therefore, for that reason and because there is an issue with community treatment orders, I believe that putting this in the Bill will not just change the practice but get the correct safeguards for people who are put on them. I would like to test the opinion of the House.

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[Baroness Barker (LD)]

My Lords, at this stage I do not wish to detain the House for very long. I will simply reflect on the fact that, when we debate mental health legislation, we are always trying to do three things: one is to update current thinking in legislative circles on what patients want and need; the second is to try to gently confront the sometimes conservative disposition of practitioners, by pushing for progress; and the third is that we try to avoid the situation where the biggest imperative for legal change is scandal and crisis when something goes wrong.

The amendments put forward by the noble Baroness, Lady Watkins, along with others proposed by noble Lords in this group, do that. They have reflected on what has been seen over the last 10 to 15 years in the patient experience and the most progressive aspects of professional development, in particular the growing acceptance that patients can have informed insight into their condition, even if they are at times very ill.

That is why a number of practitioners—admittedly in the face of some professional resistance in other quarters—have gone down the route of advance choice documents. The key thing I will say to the Minister is this: it is always difficult in mental health practice to come across evidence which is up to the same standards that we have in physical health—namely, randomised controlled trials. However, there have been randomised controlled trials of advance choice documents in a number of different places around the world, and in the United Kingdom. They may not always have been called advance choice documents—they may have had other names—but the findings from those trials say that these are cost-effective interventions.

However, we know that there will not be widespread uptake, that attention will not be paid to what people have put in those documents, and that they will not become standard practice unless they are in law. That is why the noble Baroness, Lady Watkins, was right to come back to try to put this in the Bill.

[Baroness Merron (Lab)]

My Lords, I thank noble Lords for their contributions. I will take each amendment in turn.

The points on trauma were made extremely well and sensitively. Amendments 12 and 13 recognise the impact that childhood trauma can have on psychological well-being. This is indeed so. However, it does not apply to all patients, and that is why we do not wish to restrict decision-making by giving particular reference to this in legislation. I can point to Clause 8, which already requires decision-makers to consider the nature and degree of the disorder and all other circumstances, which could include childhood trauma. The definition of medical treatment under the Act is broad, as noble Lords have seen. Therefore, we expect it to cover interventions aimed at minimising distress and promoting psychological well-being. Additionally, NHS England’s care standards require that in-patient care be trauma informed.

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[Earl Howe (Con)]

My Lords, I will speak briefly to the amendments in this group tabled by my noble friend Lady Berridge, supported by the noble Lord, Lord Meston, and the noble and learned Baroness, Lady Butler-Sloss, whose last suggestion I hope will be listened to by the Minister.

I must commend my noble friend for her tenacity with this issue. As she has outlined, there is a significant concern that the use of the county courts to decide on matters pertaining to the termination of nominated persons is not the most appropriate process. I do hope that the Minister will give my noble friend words to her comfort.

[Baroness Merron (Lab)]

My Lords, I thank the noble Baroness, Lady Berridge, for her Amendments 24, 28 and 35. They would mean that the mental health tribunal, rather than the county court, handled the termination of appointment of the nominated person. The county court already has a role in displacing the nearest relative. It has the expertise, procedural tools and legal framework to handle sensitive disputes involving external parties, such as conflicts of interest or allegations of abuse. The First-tier Tribunal (Mental Health) in England and the Mental Health Review Tribunal for Wales are focused on reviewing detention under the Mental Health Act. This would add an additional burden on the tribunal, risking undermining its core function and delaying detention reviews.

The noble Baroness, Lady Berridge, raised the issue of legal aid. County court mental health cases are largely limited to applications for the displacement of a nearest relative. Legal aid is currently available to a person seeking the displacement of the nearest relative, except where the person bringing that application is doing so in a professional capacity and to the nearest relative themselves. That would also apply for the nominated person, which will replace the nearest relative.

Legal representation is available where the applicant meets the means test, unless they are under 18, and the relevant merits criteria. If there are any further points of clarification, I will be pleased to make them to any noble Lords who have raised points today, including the noble Baroness.

As we do not feel that the mental health tribunal is the right place for what I was referring to before I went on to legal aid, I ask the noble Baroness to withdraw the amendment.

[Baroness Butler-Sloss (CB)]

Does the Minister know which judge deals with these issues in the county court? The point that I made as a possibility was that it should be one of the family judges. She will know that circuit judges do both family and civil, but generally there is a designated family judge and a designated civil judge. I am just hoping something can be said so that it gets at least to a judge like the noble Lord, Lord Meston, who would understand what was going on.

[Baroness Merron (Lab)]

The noble Lord, Lord Meston, does indeed know what is going on—I agree. I cannot answer the noble and learned Baroness’s question directly, but I would be pleased to look into that point in order to do so. Maybe the noble Lord could help me.

[Lord Meston (CB)]

Perhaps I can relieve the Minister. I can tell her who has to deal with it: it is whoever is available at the time, and these applications tend to come in really quite urgently.

[Baroness Merron (Lab)]

I am most grateful to the noble Lord.

[Baroness Berridge (Con)]

I am grateful for the Minister’s comments, the reassurance she has given and the details she will provide me with, so I beg leave to withdraw the amendment.

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Moved by

[Baroness Merron]

26: Schedule 2, page 74, line 27, leave out from “writing” to end of line 19 on page 75 and insert “signed by the patient in the presence of a health or care professional or independent mental health advocate (“the witness”),
(c) the nominated person has signed a statement that they—(i) meet the age requirement (see paragraph 2(2)), and(ii) agree to act as the nominated person, and(d) the witness has signed a statement that—(i) the instrument appointing the nominated person was signed by the patient in the presence of the witness,(ii) the witness has no reason to think that the patient lacks capacity or competence to make the appointment,(iii) the witness has no reason to think that the nominated person lacks capacity or competence to act as a nominated person,(iv) the witness has no reason to think that any fraud or undue pressure has been used to induce the patient to make the appointment, and(v) the witness has no reason to think that the nominated person is unsuitable to act as a nominated person.”Member’s explanatory statement
This changes the process for appointing a nominated person. It removes the requirement for the nominated person’s signature to be witnessed and the various statements and signatures no longer have to be contained in the same instrument.

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Moved by

[Baroness Merron]

29: Schedule 2, page 77, line 27, leave out “16” and insert “18”
Member’s explanatory statement
This and my amendments to paragraph 10 of new Schedule 1A ensure that where a nominated person is appointed for a patient who is aged 16 or 17 and for whom a local authority has parental responsibility, the local authority is appointed as the nominated person.

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Moved by

[Baroness Merron]

33: Schedule 2, page 78, line 23, at end insert—
“10A “(1) This paragraph applies where an approved mental health professional is deciding who to appoint as a nominated person for a relevant patient who is aged under 16.(2) If a local authority has parental responsibility for the relevant patient, the approved mental health professional must appoint that local authority.(3) If no local authority has parental responsibility for the relevant patient but there are one or more other persons who have parental responsibility and who are willing to act as the nominated person, the approved mental health professional must appoint one of them.(4) In any case in which sub-paragraphs (2) and (3) do not identify who is to be appointed, the approved mental health professional must, in deciding who to appoint, take into account the relevant patient’s past and present wishes and feelings so far as reasonably ascertainable.”Member’s explanatory statement
This largely replicates the effect of existing paragraph 10 of new Schedule 1A but ensures that where a nominated person is appointed for a patient who is aged under 16 and for whom a local authority has parental responsibility, the local authority is appointed as the nominated person.

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Moved by

[Baroness Merron]

36: Clause 30, page 42, line 1, leave out “50” and insert “36”
Member’s explanatory statement
This is consequential on my amendment to leave out clause 50.

Mental Health Bill [HL]

Baroness Merron Excerpts

Report stage
Monday 31st March 2025 Lords Chamber

Moved by

[Baroness Merron]

39: Clause 36, page 52, line 4, leave out subsection (5) and insert—
“(5) In section 143 (general provisions as to regulations, orders and rules)—(a) for subsection (2) substitute—“(2) The following are subject to annulment in pursuance of a resolution of either House of Parliament—(a) any Order in Council under this Act;(b) any order made by the Secretary of State under section 54A or 68A(7);(c) any statutory instrument containing regulations made by the Secretary of State under this Act, other than regulations made under section 48B(3);(d) any statutory instrument containing rules made under this Act.”;(b) after subsection (3) insert—“(3ZA) A statutory instrument containing regulations under section 48B(3) (whether alone or with other provision) may not be made unless a draft of the instrument has been laid before and approved by a resolution of each House of Parliament.””Member's explanatory statement
This is consequential on my amendment to clause 18, page 26, line 6.

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Moved by

[Baroness Merron]

45: Leave out Clause 50
Member's explanatory statement
The material in this clause is, so far as it needs to be retained, inserted into clause 36 (see my amendment to that clause).

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Moved by

[Baroness Merron]

46: After Clause 51, insert the following new Clause—
“Review of duty to notify incidents(1) The Secretary of State must carry out a review into—(a) whether regulation 18 of the Care Quality Commission (Registration) Regulations 2009 (S.I.2009/3112) (duty to notify incidents) ought to be extended to require a notification to be given in any other cases in which a person under the age of 18 is admitted to a hospital or registered establishment for medical treatment for, or assessment in relation to, mental disorder, and(b) whether the time period mentioned in regulation 18(2)(h) of those Regulations remains appropriate.(2) The Secretary of State must prepare and publish a report setting out the conclusions of the review.(3) The Secretary of State must lay a copy of the report before Parliament.(4) The report must be laid and published before the end of the period of 2 years beginning with the day on which this Act is passed. (5) In this section the following expressions have the meaning given by section 145 of the Mental Health Act 1983—“hospital” ;“medical treatment” ;“mental disorder” ;“registered establishment” .”Member's explanatory statement
This requires the Secretary of State to carry out a review into the circumstances in which incidents involving mental health patients under the age of 18 ought to be notified to the Care Quality Commission.

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

My Lords, having heard the concerns of noble Lords in Committee around the placement of children and young people, we want to go further than when we started. It is a statutory requirement for CQC to be notified when a person under 18 is placed in an adult psychiatric unit for longer than 48 hours. CQC takes action to assess risk and ensure the child is being safeguarded. Government Amendment 46 will now require the Secretary of State to review whether current notification requirements should be extended to other incidents and whether the 48-hour time period remains appropriate. A report on the findings of this review must be laid before Parliament within two years.

I am also pleased to announce today that NHS England will use existing powers under the NHS Act 2006 to require ICBs to provide information, first, on accommodation or facilities for patients under the age of 18 and, secondly, on any incidents where a person under the age of 18 is placed in a setting that is clinically appropriate but is outside of the natural clinical flow or not in a specialised children and young people’s mental health ward. Those requirements will be set out in the new service specification and made clear in the revised code of practice. Collecting this information is crucial to enable NHS England to monitor and minimise risk and make the case for changes in local capacity to meet population needs.

Finally, I am pleased to announce that we will lay regulations under existing powers to require ICBs to provide information that CQC reasonably requests and to publish an action statement where directed to do so by CQC. This will strengthen CQC oversight of how it monitors the application of the Act in local areas, such as the duty on ICBs under Section 140 to notify local authorities specifying hospitals where arrangements are in place for the provision of accommodation and facilities for children and young people. I hope that noble Lords will feel able to support this amendment. I beg to move.

[Baroness Browning (Con)]

My Lords, I just want to clarify something, as the Minister has referred quite a lot to NHS England and its role going into the future. My understanding is that there is a sea change due at NHS England. How can we be sure that some of these roles, which are very important to this Act, will still be there and that they will be the people who will be responsible?

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[Baroness Merron (Lab)]

I will answer the question at the end for simplicity; I do have an answer for the noble Baroness.

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[Baroness Browning (Con)]

My Lords, very briefly, I added my name to this amendment, but I of course support the amendment from the noble Lord, Lord Meston—it is urgent to have an answer to that when the Bill proceeds.

I support all that my noble friend on the Front Bench said about children in adult wards, but I particularly focus on his request for attention to out-of-area placements. We know, from many of the cases that, sadly, we have had to debate in this House, that, when people are detained unduly—almost as though they are placed somewhere and the keys are thrown away—it is all too often because they are well away from their home base and from convenient visiting by relatives, and, as my noble friend said, often far away local authorities that might have had some sort of overview of them previously.

This is very difficult. We know that local authorities are stretched financially, and, presumably, keeping an eye on what is happening to somebody who has gone well out of their area has a clear cost implication. None the less, we are talking about children. Therefore, I support my noble friend and I hope the Minister will find a way forward to support these children.

[Baroness Merron (Lab)]

My Lords, I thank all noble Lords across the House for their contributions during the debate on this group, the last of the evening. I am glad that both Front Benches welcome government Amendment 46, albeit I heard the noble Earl, Lord Howe, say that he had hoped that we would go further. I am glad that the other commitments made at the start of the debate were welcomed.

Amendment 58 was tabled by the noble Earl, Lord Howe, supported by the noble Lord, Lord Kamall. We agree with the intention of this amendment but do not believe that placing more limitations and prescriptions in legislation is the best vehicle to reduce the placement of children in certain settings.

In Committee, I set out existing measures to address and monitor this issue. The latest data from the CQC’s Monitoring the Mental Health Act in 2023/24 report shows that it was notified of 120 instances where a person under the age of 18 was admitted to an adult ward, which was a 38% decrease compared to 2022-23. I committed to set out guidance in the revised code on the process to determine whether a placement is in a child’s best interests, and to ensure that safeguards are in place. NHSE will also do this in the new service specification—I will return to this point for the noble Baroness, Lady Browning. I hope that the additional commitments we have made in this debate show that the Government take this matter seriously and that we are committed to continuing to work on and address this issue.

To the point that the noble Baroness, Lady Browning, made about NHSE, I assure her that, as we work to bring the two organisations together—NHSE and DHSC—we will ensure that we continue to evaluate impacts of all kinds and that the functions currently undertaken by NHSE will continue along with that change. It will take some two years for the full process, including legislation, to take effect. However, admin changes are happening more immediately. The main thing of which I want to assure the noble Baroness is that the change into the future will not affect the commitments that we have given; they will continue, and without duplication.

Before I turn to Amendment 51, I will go back to the noble Earl, Lord Howe, who asked whether we would undertake a concerted effort to look at other directions of the issue, such as training and suitable in-patient or outreach mental health services. In response, I can say that, subject to securing further investment, NHS England is developing a new model for specialised children and young people’s mental health services, which will be supported by a new service specification and quality standards. The priority for these services is to transform and expand community services to make sure that there are local accessible community alternatives and to reduce the need for admission and dependency on in-patient beds, as well as reducing the length of stay and keeping young people closer to home. I hope that the noble Earl will appreciate that we are in the same place on this and that it is a matter of actually putting it into action.

I return to Amendment 51, which was tabled by the noble Lord, Lord Meston, and spoken to the noble and learned Baroness, Lady Butler-Sloss, and other noble Lords. We believe that the Mental Health Act is not the appropriate legislative vehicle to set out a statutory test for competence for under-16s, and nor would it be appropriate to seek to establish a test in a single setting. We are not satisfied that the possible implications for mental health in other settings where Gillick is applied have yet been fully explored.

The principle of Gillick competence is established in case law, as noble Lords will be aware, not statute. Any statutory test should reflect existing case law and would not necessarily override the application of Gillick outside the Act. The design of the test is partly aligned with the tests set out in the Mental Capacity Act. There is no consensus in the courts, as noble Lords will be aware, on whether it is appropriate to apply these tests to test competence in children under 16.

The noble Lord, Lord Meston, raised the question of unintended consequences, to which I am able to respond. The creation of any test that does not consider the interaction with existing case law could inadvertently limit the ability of children detained under the Act to exercise choice and autonomy under their care and treatment. Those are the concerns about unintended consequences.

We are also greatly concerned that, in seeking to provide clarity on assessing competence in mental health settings, two different tests could be created. This is likely to cause further confusion and a risk of legal challenge for decision-makers in mental health settings, potentially in any setting where Gillick is applied. This could have unintended consequences—I use that phrase again—for the ability of children to exercise choice and autonomy, as I have already mentioned, which I hear is counter to the noble Lord’s intention.

The noble Lord will understand that we cannot comment on or prevent how, as I say, courts will interpret the test or whether there will be further calls for similar tests. The courts may even go as far as to apply this test in other settings. That is what we mean when we say the introduction of a test for decisions under the Act will or may cause confusion and uncertainty in other settings. We do not think the consequences of this have been given proper consideration, nor can this risk be appropriately mitigated. We will consult on the statutory guidance for assessing competence in mental health settings, as I have mentioned, in the revised code of practice. I hope that will meet the intention to provide further clarity.

The noble and learned Baroness, Lady Butler-Sloss, asked what additional support would be provided to clinicians in engaging with children and young people, as we are rejecting this amendment. The Mental Health Act code of practice already provides guidance on establishing competence in under-16s. As I have said, we will consult on the guidance in the revised code of practice. I also re-emphasise that we feel it is better to focus on improving the practical application of Gillick rather than create or risk further confusion.

I hear that there are differences of opinion. While I am sure that what I say will not completely satisfy noble Lords who have raised concerns, I hope it gives a sense of where we have got to and the reasons. I therefore hope that these reasons will convince noble Lords not to press their amendments.

Amendment 46 agreed.

Food, Diet and Obesity Committee Report

Baroness Merron Excerpts

Friday 28th March 2025 Lords Chamber

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

My Lords, I welcome the Food, Diet and Obesity Committee report. Like many noble Lords, I express gratitude to the chair, the noble Baroness, Lady Walmsley, and to all members of her committee for their dedication and insight into improving the health of the nation. My thanks also go to those who contributed their time and expertise in providing evidence and support for the committee’s work. As noble Lords will be aware, the Government published their response to the report on 30 January following the publication of the committee’s report in October.

This has indeed been a very valuable debate, and I am grateful to all noble Lords for their wisdom, experience and contributions. It has been acknowledged throughout that one thing we are in full agreement about is the characterisation of the problem as set out in the report. As highlighted by many noble Lords, including the noble Baronesses, Lady Manzoor and Lady Meyer, and my noble friend Lady Brown, we face a childhood obesity crisis. Well over a third of children are living with obesity or are overweight by the time they leave primary school. It is not equal across the country. This is a matter that disproportionately affects those in disadvantaged areas. As the noble Lord, Lord Rennard, highlighted, among other things, we also have some two-thirds of adults overweight or living with obesity.

The impact is huge, increasing the risk of many serious diseases, exacerbating mental health issues and reducing the years lived in good health, as the noble Lord, Lord Bethell, bringing to bear his experience as a former Health Minister, rightly observed. We know that prevention will always be better than cure. The noble Baroness, Lady Manzoor, referred to the evidence on this found by the noble Lord, Lord Darzi, on which he commented strongly. It will form one of the three pillars of the 10-year health plan. It is also why prevention is at the heart of our health mission.

As noble Lords know, I really do not like to disappoint them and particularly do not like to disappoint the chair of the committee, the noble Baroness, Lady Walmsley. I heard not just from the noble Baroness but from others their observations, which included disappointment at the Government’s response. I hear that and will endeavour to respond in a way that I hope noble Lords will find helpful to alleviate some disappointment. I am sure noble Lords will tell me whether I succeed.

We need to tackle the root causes of obesity. My noble friend Lady Brown was absolutely right to highlight the impact of poverty and homelessness, and all that those mean. We have to address, as we have heard today, the increasingly unhealthy changes in our food environment and make healthier choices cheaper, more attractive and more available in order that the healthy choice is not just the easy but the smart choice. As the noble Baronesses, Lady Freeman and Lady Browning, said, it is about equipping people—I bow to the experience and cookery skills of the noble Baroness, Lady Browning, in this regard—with skills because unless they are equipped, it is just not going to happen.

Looking at what action has been taken so far, I do not pretend for a moment that this is a speedy or simple task. The committee expressed its concerns that the actions taken—at the time of the report, I might add—were not bold enough, nor was the Government’s response, and nor was it moving fast enough, as the noble Baroness, Lady Jenkin, particularly said, in its urgency.

A number of noble Lords have been good enough to refer to the actions that have already been taken. Since coming into government in July, we have indeed laid secondary legislation to restrict advertisements of less healthy food and drink to children on TV and online from 1 October this year. My noble friend Lady Goudie recalled that that had not happened previous to this Government and referred to the strong voice of industry against this measure. I certainly remember, when in opposition and standing at the Dispatch Box opposite, urging action. I am glad that we have done this.

A number of noble Lords spoke about the influence of industry. I will come back to this later, but it is not my experience, either as a Minister in this Government or the previous Labour Government, that because I spoke with industry or any other stakeholders, I necessarily agreed with or felt pressured by them. I heard the comparisons that the noble Lord, Lord Rennard, and the noble Earl, Lord Caithness, made with the tobacco industry. I can absolutely say, as a former Public Health Minister, it was not my experience that because they were spoken to by those with a different view, our previous Labour Government—or indeed this one—went along with that.

What I do believe in is transparency. The noble Baroness, Lady Boycott, referred to figures under the previous Government of the numbers of meetings. The noble Baroness and all noble Lords will know that it is required—and absolutely right—that Ministers and others declare their interests and, more than that, the meetings we have. That is absolutely crucial and I am completely on board with doing that.

Another area in which we have taken action has also been referred to. I am glad the noble Baroness, Lady Coffey, was good enough to support this. We have given local authorities stronger and clearer powers to block new fast-food outlets near schools and where young people congregate.

We have gone further than our manifesto commitments. The October Budget uprated the soft drinks industry levy and I thank my noble friend Lord Brooke for continuing to highlight this. That action, as we know, has taken thousands of tonnes of sugar out of the drinks that are consumed every day. I believe, and it is evidenced, that this uprating will keep this action effective and continue to drive reformulation by industry towards healthier products.

We know that we need to go further. The noble Baroness, Lady Coffey, reminded us of the challenge for individuals, not just the system. I appreciate how personally she told us of those challenges. It is not just the complexity of the landscape, as noble Lords have said and I agree, but the complexity of the challenge for individuals, referred to very personally by the noble Lord, Lord Rennard. It is right that we support, guide, educate and make it possible for individuals to be part of the solution. We will need new measures to further improve the food environment, more measures to trigger the reformulation of less healthy products and more support for people to make healthier choices.

I have heard the committee’s concern that it takes too long to make new policy commitments. I was reflecting on this when preparing for this debate and I take that point. The Government’s response, which was made not many months after coming into government, was made in January this year but it was started as soon as we received the committee’s very welcome report. Being realistic, the Government were not ready to make firm positions on introducing, or indeed rejecting, many of the committee’s more specific recommendations. For me, that perhaps explains or illustrates some of the reasons behind the Government’s response.

Of course, policies will be informed by strategy. I am going to use the word “complex” again, but the food system—noble Lords have illustrated this today, as they have done on many occasions—is very complex. There is a need to engage and consult with a wide range of stakeholders in government, in industry and in the health and academic sector to make sure that policies will be effective and proportionate. To take the necessary steps, we need to have the machinery in place to drive progress, bringing together many government departments including the Department for Education—I refer the noble Baroness, Lady Batters, to this point—as well as non-government stakeholders. We also need to develop and drive forward an agenda for change.

That is why, in addition to the work under way within the health mission—a new approach to government and very much a core approach—we are developing a new cross-government food strategy, as has been spoken about a lot today and as recommended by the committee’s report. The noble Baroness, Lady Batters, urged a joined-up approach across government, including the role of the Department for Education. Indeed, that department is very much part of that, as are other government departments. The food strategy will promote more easily accessible and healthy food to tackle obesity and diet-related ill-health and will help children to get the best start in life.

There has been a lot of discussion about the advisory board to the strategy. I will make a couple of additional points, alongside those that have already been highlighted. The strategy was announced on 21 March. The Minister for Food Security and Rural Affairs, Daniel Zeichner MP, is the chair, and it held its first meeting on Wednesday 26 March. The board will initially meet monthly. On the points about the composition of what is, as I have emphasised, an advisory board, Defra worked closely, and continues to, with the Institute of Grocery Distribution to establish the board, and the IGD will act as co-secretariat for the meetings.

The food strategy and the health mission are both about delivering change—the very premise on which this Government were elected. I can give the assurance that all policy options are being fully considered, recognising the need to engage with a wide range of government and non-government stakeholders. This includes engaging with the food industry, as my noble friend Lord Brooke acknowledged.

Our food environment, as noble Lords have rightly said, needs to improve. The food industry shapes our food environment, and it needs to be part of the solution. That is a point to which the noble Baroness, Lady Coffey, brought her experience in three very relevant departments to bear in this debate. Engaging in this way is vital to allow us to understand how changes may impact the food supply chain and how to deal with possible risks.

Noble Lords are eager to see progress, and so am I. I am conscious that we are not dealing with a new or unexpected problem, but one that has been allowed to develop over many years. Our reaction to that, in the form of our action plan, must include properly designed policies that have been consulted on. We need to remove barriers to implementation and set out a clear path and a timeline for delivery to avoid delay and uncertainty.

On the points about mandatory regulation, our action will not stop with the actions we have already taken. I have heard the concerns and the urgings to be bold. Former Prime Minister Tony Blair was quoted. I remember him saying:

“We’re at our best when at our boldest”.


Mandatory regulation can drive change and establish a level playing field between companies which have already taken voluntary action and those which have yet to do so.

The noble Lord, Lord Krebs, mentioned a Cambridge report which said that hundreds of policies have been failing because of a voluntary approach. The reference to the balance of voluntary and mandatory measures in the Government’s response to the committee’s report did not mean a reliance on wholly voluntary measures, nor was it “giving in”—to quote the noble Baroness, Lady Walmsley—to industry lobbying. I have already outlined the steps that we have taken, and we will fulfil our commitment to banning the sale of high-caffeine energy drinks to under-16s. We will not shy away from taking necessary mandatory action. I believe we have already shown ourselves to be going in that direction where it is needed and where it will produce the best result.

On the important matter of supporting children, I say to the noble Baroness, Lady Meyer, that taking a life course approach is key to our commitment to give every child the best start in life. Again, I reassure noble Lords that the Department for Education has an important role in achieving that. All of this starts with helping families to access support for feeding their baby. For those who use infant formula, it is vital that they can access affordable and high-quality products—something that I know is of interest to the noble Baroness, Lady Suttie. We therefore welcome the Competition and Markets Authority’s formula report. We will consider carefully the recommendations and will respond to it. The affordability and availability of healthy food is key for those trying to feed their family. We are committed to providing a healthy diet for young people and providing support to families who need it most through our Healthy Start scheme.

The issue of mandatory school food standards was raised by my noble friend Lady Brown and the noble Baronesses, Lady Goudie and Lady Freeman, among others. These standards are in place throughout the school day. I assure the noble Lord, Lord Rennard, that they apply to the new school breakfast clubs. I have heard the concerns of noble Lords. The DfE keeps the approach to school food and ensuring compliance under review. Our two departments will continue to work together.

I turn quickly to ultra-processed foods. I agree that further research is needed to establish why and whether these foods are unhealthy: is it the processing or the nutritional content? As we have heard in the debate from the noble Lords, Lord Krebs and Lord McColl, and the noble Baronesses, Lady Boycott and Lady Suttie, there is a difference of opinion about this. That is why the SACN regularly reviews new and emerging evidence and will publish statements on UPFs and non-sugar sweeteners. We are also commissioning new research.

Once again, I thank the committee for its report. It articulated the seriousness of the challenge. I hope that, today, I have described some of the mechanisms through which we will work to drive change. We know we have to go further, where previous Governments have not done so. I look forward to being able to set out further actions that we will take in due course.

Covid-19: Day of Reflection

Baroness Merron Excerpts

Thursday 20th March 2025 Lords Chamber

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

My Lords, I too congratulate the right reverend Prelate on securing this important and touching debate, which was somewhat inevitable, considering the subject. I acknowledge her ongoing dedication. Since chairing the UK Commission on Bereavement and the publication of the report, the right reverend Prelate and the commission have continued to champion this important issue. I am very happy to agree to the meeting that she requested.

I am grateful to the noble Lord and the noble Baroness on the Front Benches, not only for sharing their personal experiences and reflections, which is what this subject is about, but for raising the points that they did. I know that they, like me and the right reverend Prelate, want to improve support for those who are bereaved.

The right reverend Prelate made the very good point that there is bereavement through the loss of a loved one, but there is also bereavement through the loss of what might have been. One such example of that, writ large, is those who have long Covid—and I am sure that we can all think of others. It is always right to think about loss in those terms. As has been said, we all have and will experience grief through the course of our lives. It is absolutely vital that bereaved families and friends have access to the support that they need, and when they need it. That can come from a variety of sources, as noble Lords have described, and I will return to that later.

I assure your Lordships’ House that the Government are looking for the best ways to support those in grief, including those bereaved as a result of Covid-19. On behalf of the Government, I also associate myself with the thanks to those who provided services with full public spirit, no matter what sector they were from. Whether private, public, charitable or voluntary, they were public spirited to the core and they kept us going. I am deeply grateful. I also reiterate the condolences to all those who were bereaved and all those who suffered loss of some kind and have been affected by the pandemic.

Noble Lords have referred to the day of reflection. This year marked the fifth such event since the outbreak of the pandemic. As we have heard, it is a significant milestone and an opportunity to form one’s thoughts, memories and actions as we remember all those who were affected.

The noble Baroness, Lady Morgan of Cotes, chaired the UK Commission on Covid Commemoration to consider appropriate ways to remember those who have died and how we should mark such a sombre time in our history. Of course, it is not history for those who are bereaved; it continues to be with them. I thank the noble Baroness, Lady Morgan, and the commission for their extensive work in speaking with those who are most impacted by the Covid-19 pandemic, including representatives from bereaved family organisations. I am grateful to those organisations for their work.

The commission’s first recommendation of 10 is that:

“A UK-wide day of reflection should be established and held annually on the first Sunday of March”.


On 9 March this year there were more than 200 events in communities across the country, and we saw how important this day was to so many. The noble Lord, Lord Kamall, asked about a day of reflection in the future. We see how much this day matters to people and how many communities took part, and I thank all those local organisations and communities for contributing to that. We very much hope that will create a foundation for future years.

The day of reflection allowed people to remember the many losses in a way that was appropriate and meaningful for them. It struck me to be very much in contrast to our experiences during the pandemic, which for that period of time were ones of isolation, separation and the loss of the lives we used to lead. There was close working with charities, faith groups and other voluntary, community and social enterprise organisations. That was very much the mark of the day of reflection, and I appreciate the role of those organisations, not just in the day of reflection but in supporting those who experience grief. I am sure we all pay tribute to them and their work.

In Sheffield the city council continues to work in partnership with Compassionate Sheffield, which aims to improve people’s experiences of life, loss and death. Access to support is certainly important; it has been referred to throughout this debate. To give just one example, of which noble Lords will be aware, the Government are prioritising funding to expand NHS talking therapies. That is something to which people can self-refer, or they can consult their GP in order to get to that point, and it is a tremendous service for people.

The noble Baroness, Lady Brinton, rightly referred to the issue of children and young people’s mental health. Again, I mention the expansion of mental health support teams in schools, putting in place Young Futures hubs, which will provide access to mental health support, and the recruitment of 8,500 new mental health workers to treat children and adults. In all these ways, we hope to support children and young people who are bereaved.

On the point the noble Baroness, Lady Brinton, raised about PPE, we are responding to each of the reports from the inquiries, and that will be dealt with. I totally agree about keeping people safer and the matter of Zoom. That has provided comfort in a way we could not possibly have anticipated. I noted her comments about ads for very cheap funerals, and I will raise them with the appropriate ministerial colleagues.

The noble Lord, Lord Kamall, talked about culture. Indeed, different religions and communities have different cultures. As he will know, in the Jewish tradition, it is tradition to sit shiva for around a week, where support can be freely given by visiting the home of the bereaved. As my noble friend Lady Anderson reminded me, it is hard to get a group of people together and not feel some form of celebration while giving that support. All these models are ones that we can look to.

On the points made about long Covid—which is a very real issue and will not be going away—we have invested £314 million to expand treatment and rehabilitation services and established 100 long Covid services for adults and 13 specialist paediatric hubs for children and young people. They assess people with long Covid and direct them into ways of care, to provide the right support, treatment and rehabilitation. We have also invested £50 million in 22 research projects for long Covid. In all this, I hope people can be reassured that we continue to support people.

On the question about adding bereavement to the national curriculum, we are reviewing the RSHE curriculum and will look carefully at responses to the consultation on the draft revised RSHE statutory guidance, which ended in July. I will take a particular interest, with my ministerial colleagues, about where that sits.

My department brings together government colleagues to discuss bereavement as part of a government working group on bereavement. It is a forum to share best practice. Today’s debate will feed into that very well. We take the reports from the UK Commission on Bereavement very seriously and continue to engage with them.

On the right reverend Prelate’s point about end of life, dying well is a fundamental right in regard to human dignity and compassion. We have a responsibility to ensure the best possible care. That includes supporting families and carers, including young people, who are involved in that.

NHS England has developed guidance to support ICBs with their duty to commission palliative care services within integrated care systems. That guidance requires commissioners to ensure that significant access to bereavement services be available for families and carers, including children and young people.

I turn to ongoing research. The pandemic made clear the need for bereavement services to offer both practical and emotional support, as noble Lords have referred to. Noble Lords will not be surprised that not everybody knows about these services. Many services are particularly not reaching those from ethnically diverse communities. Through the National Institute for Health and Care Research, the Government have commissioned a study investigating how to improve bereavement services for those from ethnically diverse groups. That includes those from black African, black Caribbean, Pakistani, Bangladeshi, Indian, Somali, Chinese and Roma backgrounds. I certainly look forward to the study’s findings, which will be published later this year.

Finally, we need to take an evidence-based approach to health, and NICE balances best care with value for money across the NHS. Decisions on whether NICE will create new or update existing guidance are overseen by a prioritisation board chaired by NICE’s chief medical officer, and the prioritisation board is considering bereavement as a potential topic for guidance development.

In reiterating my sympathies to all those who were bereaved and all those who continue to be affected directly or indirectly by the Covid-19 pandemic, I feel that it is incumbent on us to look to make further progress on bereavement support services. I look forward to continued cross-government working—and, I am sure, cross-party working—to achieve this.

Pharmacy Opening Hours

Baroness Merron Excerpts

Thursday 20th March 2025 Lords Chamber

[The Lord Bishop of St Albans]

To ask His Majesty’s Government what assessment they have made of the impact of the potential reduction in pharmacy opening hours.

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

My Lords, this Government recognise that pharmacies are an integral part of our communities. There are processes in place to monitor opening hours and their impact, and core hours of either 40 or 72 hours would not be affected by the proposed action by one trade body. Options are available to patients to access alternative pharmacies or distance-selling pharmacies. We will make an announcement shortly on a funding settlement for the years 2024-25 and 2025-26.

[The Lord Bishop of St Albans]

I thank the Minister for her response. Will His Majesty’s Government publish the independent economic analysis of the pharmacy funding crisis? Also, last summer we nursed my brother-in-law as he died. We had to access medicines, often at short notice. That was very difficult, even in a built-up urban area with many pharmacies around. In rural areas, it is far more difficult. What assessment have His Majesty’s Government made of any limitation of opening hours on health outcomes in rural areas?

[Baroness Merron (Lab)]

I will of course discuss the right reverend Prelate’s request for publication of information with Minister Stephen Kinnock, who has been working very hard with the sector in resolving matters on funding.

On opening hours, as I have said, there are core hours, but there are also additional supplementary voluntary hours that community pharmacies can choose to do. There is also a whole range of ways in which people can access pharmacy services—notwithstanding the point the right reverend Prelate made about his personal experience—including being able to contact distance pharmacies, which can provide things through online contact, by telephone call or by other means.

Pharmacies are key to making healthcare fit for the future, but we want to make sure that they are completely accessible. We will work with them to make sure that they, as largely private businesses, do so.

[Lord Kakkar (CB)]

My Lords, I draw noble Lords’ attention to my interest as chairman of King’s Health Partners. Just to build on the point made by the right reverend Prelate, what assessment have His Majesty’s Government made of the impact on population health outcomes of the intersection between limited access to primary care services and diminishing availability of pharmacy services?

[Baroness Merron (Lab)]

I know the noble Lord talked about primary care more generally, but the assessment on pharmacies is that there is quite a good coverage. Some 80% of the population live within a mile of a pharmacy and, as I say, there are other online and not-in-person ways of contacting pharmacies. The Pharmacy Access Scheme provides financial support to pharmacies in areas where there are fewer pharmacies. Local authorities, along with ICBs, continue to monitor changes, look at provision and have the ability to intervene where necessary. On all these counts, in respect of primary care provided through pharmacy, which is so important, we continue to monitor the impact across ICBs. With regard to a particular assessment, I will gladly write with more details to the noble Lord.

[Lord Kamall (Con)]

My Lords, the Minister has rightly talked about some of the alternatives, particularly when hours are limited. Can I ask her about some of the long-term thinking in the department on the future of pharmacy services? We know that some chains, for example, have in-store pharmacies. What thought has been given to more of these partnerships—and also, perhaps, pharmacies as part of future primary healthcare centres? While many people may want a bricks and mortar pharmacy, those who use the NHS app, for example, may be happy to order repeat prescriptions and have them delivered or pick them up from a local location.

Patients are also more open to ideas of online consultation. We have seen Royal Mail trialling delivery by drones in remote areas. There is a whole host of things happening in other sectors that the pharmacy sector and other parts of our health and care sector can learn from. What is the department learning from this innovation in other parts of the economy?

[Baroness Merron (Lab)]

The noble Lord makes some very constructive points and illustrates further the point that there are many ways to deliver pharmaceutical services. I can assure him that we are exploring how pharmacy can best be positioned—and indeed levered—to fit our ambition for a neighbourhood health service within the NHS 10-year plan. More will be heard about that soon.

The noble Lord will also be aware that one of the challenges that community pharmacies raised with us is about funding, which was cut or held flat between 2015-16 and 2023-24, representing a cut of some 28%. That is why we have concluded the consultation about funding; we will shortly announce the outcome, looking at how these private businesses can operate in the market. We are keen to ensure that they play their part and continue to work very constructively with them.

[Lord Scriven (LD)]

My Lords, the financial year ends in two weeks, and the ongoing delay in this year’s financial settlement for pharmacists has created a cash-flow problem and exacerbated the financial issues, which means that on average eight community pharmacies a week are closing. In December the chief executive of Community Pharmacy England wrote to Ministers asking for a remedial injection of cash to help cash flow and keep pharmacies open. I gently ask the Minister why Ministers have so far ignored that request.

[Baroness Merron (Lab)]

I feel that the most constructive response I can give to the noble Lord is the response of the Secretary of State, who has made it quite clear in Parliament that discussions will conclude shortly and an announcement will be made in the normal way. That will be via an open letter to contractors, which will be published on GOV.UK. I hope the noble Lord will understand that I cannot say more until our engagement with Community Pharmacy England, the representative body, comes to a conclusion. I can add for the benefit of noble Lords that NHS England commissioned an independent economic analysis of the cost of providing pharmaceutical services. It has informed the consultation with the sector and will be published in due course.

[Baroness Wheatcroft (CB)]

My Lords, is the Minister concerned that GPs’ tendency very easily and readily to sign repeat prescriptions increases the demand on pharmaceutical services? Does she agree that there should be a much more rigorous review of repeat prescriptions on a regular basis?

[Baroness Merron (Lab)]

I appreciate the noble Baroness’s views. Indeed, community pharmacies in England are dispensing around 1.1 billion NHS medicines with a value of over £10 billion each year. Prescribing is of course a clinical decision. We are nevertheless keeping an eye on the situation, of course. What matters is that people seek help, and I am very glad to say that pharmacies are playing an increasing role in the availability of assistance, so people do not always have to go to GPs, particularly for some of the more common conditions.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, does my noble friend agree that community pharmacies play a vital role in addressing NHS waiting lists through the administration of the vaccination programme—whether it is influenza or the Covid-19 vaccine—and thereby contribute to the reduction in the waiting lists that are faced by many hospitals throughout the UK? Will all efforts be made by government to ensure that the challenges faced by community pharmacies at present will be resolved in the near future?

[Baroness Merron (Lab)]

I certainly agree with my noble friend’s point. I hope that she has noticed my enthusiasm for the role that pharmacies play. The introduction of Pharmacy First was a tremendous contribution to some common-sense approaches so that people who have common conditions can more immediately access services. Many of us will have experienced that. As I have said, we will conclude matters shortly and look forward to making the decision about future funding known ASAP.

NHS Dentistry

Baroness Merron Excerpts

Wednesday 19th March 2025 Lords Chamber

[Lord Young of Cookham]

To ask His Majesty’s Government what steps they are taking to improve access to NHS dentistry.

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

My Lords, we are tackling the challenges for patients trying to access NHS dental care by providing 700,000 more urgent dental appointments per year, with integrated care boards delivering those extra appointments from 1 April 2025, which is not long away. We will recruit new dentists to the areas that need them most and to rebuild dentistry in the long term we will reform the dental contract with the sector and shift to focus on prevention and the retention of NHS dentists.

[Lord Young of Cookham (Con)]

I very much welcome the 700,000 extra appointments, which will begin to make an impact on the 2.2 million people who now need urgent care, but did the noble Baroness read the leader in the Times on Monday which said

“the scandal of NHS dentistry has dogged successive governments without resolution”?

It mentioned the 30,000 children each year who go to hospital to have rotten teeth extracted under anaesthetic and the 18 million adults and children who cannot access an NHS dentist. Does she agree that at the root of this problem is the 2006 dental contract, which has driven dentists out of the profession? When might a new contract be introduced? Given that the most effective public health measure is to add fluoride to the water supply where it does not exist naturally, when will she roll out the programme that has begun in the north-east?

--- Later in debate ---

[Baroness Merron (Lab)]

As the noble Lord suggests, tooth decay is the main reason that five to nine year-olds are admitted to hospital. That is a scandal, and one that we are seeking to tackle. My ministerial colleague, Stephen Kinnock, has made reform of the dental contract an early priority and continues to collaborate with the British Dental Association and other representatives on what is, of course, a shared ambition to improve access to treatments for NHS dental patients. I wish I could give an exact date to the noble Lord; I am not in a position right now to do so. On water fluoridation, as the noble Lord said, an extra 1.6 million people across the north-east will benefit from a water fluoridation scheme following quite a lengthy process and that will start in 2027-28.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, dental problems put extra pressures on A&Es, particularly at the weekend when it is difficult to get access to a dentist. Does she recall that a group of dentists has suggested that we should create 40 mini-A&E centres around the country, under the NHS, open seven days a week? I believe that suggestion worked its way through to the Minister. If she is not able to give an immediate answer, would she write and put the reply in the Library for others to see?

[Baroness Merron (Lab)]

As I said, it will be ICBs delivering the extra 700,000 urgent dental appointments each year. They will be best placed locally to decide how to do it. It may well be through the means that my noble friend said, but the duty on them will be to ensure that those are available. The appointments will be most heavily weighted towards the areas where they are needed most, although appointments will be available across the country. I welcome my noble friend’s suggestion but how the extras are provided will be a matter for local decision-making.

[Baroness Watkins of Tavistock (CB)]

My Lords, can the Minister comment on whether serious consideration will be given to debt relief for newly qualified dentists? They could then work as salaried employers for the NHS and deliver more than the 700,000 appointments we are aiming at, because we have such a long backlog. That would really support children’s dental care immediately.

[Baroness Merron (Lab)]

I welcome the suggestion from the noble Baroness, and I will raise that with the Minister, Stephen Kinnock. What I can say is that strengthening the dental workforce is absolutely central, as we have to rebuild NHS dentistry in this country. Integrated care boards have started already to recruit for dental posts through a golden hello scheme. That means that up to 240 dentists will receive payments of £20,000 across three years to work in those areas that need them most. Already, as of 10 February this year, 35 dentists have commenced in post, a further 33 dentists have been recruited, and hundreds of job posts are currently advertised. There is a long way to go, but we have made a very strong start.

[Lord Rennard (LD)]

My Lords—

--- Later in debate ---

[Lord Rennard (LD)]

My Lords, the promised extra 700,000 appointments will mean just two extra appointments a month for each NHS dentist in England. The Health and Social Care Select Committee concluded in 2023 that the current dental contract is not fit for purpose, so will a new dental contract stop penalising dentists who take on more units of dental activity or patients with more complex dental needs?

[Baroness Merron (Lab)]

The noble Lord makes a very strong case for reform of the dental contract. The Minister concerned is very alive to the points he makes but, again, I will draw his attention to them. I do not quite recognise the figure that the noble Lord referred to on the number of extra appointments. If I can give just one example: out of 700,000 extra appointments, in the Midlands that will mean 143,424 extra appointments. I also emphasise that it is 700,000 extra appointments every year. If the noble Lord would let me have the figures to which he referred, I would be very happy to look into them.

[Lord Glenarthur (Con)]

My Lords, there used to be a number of eminent dentists in your Lordships’ House. I am thinking of Lady Gardner of Parkes and Lord Colwyn. I believe there are none now, so do the Government have any plans to fill this gap and ensure that the dental service is represented in your Lordships’ House?

[Baroness Merron (Lab)]

There is a cavity that needs filling. I defer to the usual channels, the senior leadership, the leaders of all parties, the Convenor of the Cross Benches, and all the other bodies that decide who should be in this House.

[Lord Kamall (Con)]

My Lords, I say to the noble Baroness that when it comes to comedy, she is doing an excellent job as a Minister.

--- Later in debate ---

[Baroness Merron (Lab)]

I can assure the noble Lord that I took his comments in good heart, which is exactly how they were intended. He touches on an important point, which is that this is not just about the number of dentists but about how many units of NHS dentistry they are doing. Again, we are very aware of that—which goes to the noble Lord’s question earlier as well—and we are seeking to resolve it through the reform of the contract. We have found that the previous Government’s dental recovery plan did not go far enough, because it has left many people still struggling to get an NHS appointment. The noble Lord asked about conversations with the Treasury, but perhaps some of that speaks for itself in that we have a rescue plan providing more urgent dental appointments. We are reforming the dental contract and not waiting to make improvements, because we are already increasing access and incentivising the workforce to deliver more NHS care.

NHS England Update

Baroness Merron Excerpts

Wednesday 19th March 2025 Lords Chamber

[Lord Scriven (LD)]

My Lords, the Government, with their sovereign right, propose the abolition of NHS England. Although the method of delivery is a matter for the Secretary of State to propose, governance changes in themselves will not achieve better outcomes. These Benches will continue to point out that chronic operational issues in the NHS cannot and will not be dealt with effectively until the Government show the same speed and determination to deal with the social care crisis. The Minister must know that you cannot have 13,000 hospital beds full of people medically fit for discharge and pretend that a change of who sits in what chairs in the governance of the NHS will solve that issue. When will the Government commit to a timetable to restart the cross-party talks to deal with this important issue?

The paramount—indeed, the sole—objective of any organisational change to the NHS must be demonstrable improvement of patient experience and outcomes. The Government assert that this change will improve efficiency and streamline services. However, assertions alone are insufficient. We require rigorous evidence, not mere conjecture.

Therefore, I am going to ask the Minister five questions. First, and most importantly, what detailed analysis has been conducted on the projected impact of this abolition on patient outcomes? We require more than abstract pronouncements. For instance, how will it improve cancer treatment? What will these changes do to improve access to GP services? How will they improve local integration, particularly when 50% of funding for ICBs will be reduced across the board?

Secondly, what specific legislative changes are required to abolish NHS England and redistribute its functions? I note that the Secretary of State pointed out that the Government could predominantly go ahead with these changes but that legislation is required, so will the Minister explain to the House exactly what legislation will be required to bring about this change? Will she give a commitment that no redundancies will take place until legislation has been passed and these changes have been given the go-ahead by this House and the other House?

Talking of redundancies, my third question is: what are the estimated costs of redundancies associated with the abolition of NHS England, including not only financial implications but the potential loss of expertise and institutional knowledge? Furthermore, will the Minister indicate whether any departing executive has been offered a severance package exceeding statutory redundancy limits and, if so, how many? What justifications are there if such arrangements have been made?

Fourthly, how will the Government ensure continuity of service during the transition period? Any disruption to patient care is unacceptable, so when will there be a robust plan that outlines how essential services will be maintained, how staff will be supported and how the public will be kept informed?

Finally, in line with what the noble Lord, Lord Kamall, said, what mechanisms will be put in place to ensure ongoing accountability and transparency in the newly restructured healthcare system? How will the Government measure success—not just of the times in which people are seen but that these changes have contributed to improvements in patient care? The Government are the custodians of this vital public service and have a duty to ensure that any changes to NHS structures are driven by evidence, guided by principle and focused relentlessly on improving the lives of the people it serves. They must proceed not blindly but with clarity, so I look forward to the Minister’s answers.

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

My Lords, I am grateful to both Front Benches for their reflections and their support for the direction of travel, in certain areas. I am pleased to see the noble Lord, Lord Scriven, in his place and I wish him a full recovery. I note that the noble Lord, Lord Kamall, welcomed the moves on value for money, freeing up from bureaucracy and the need to put the patient at the centre. I am glad that he did that, because that is exactly what this is about: better services and cutting duplication.

It is probably worth my reflecting on the sentiments expressed in the other place by my right honourable friend the Secretary of State for Health and Social Care when he referred to the question of why we are doing this. The independent investigation by the noble Lord, Lord Darzi, was called for by this Secretary of State not long after we came into government and discovered a situation beyond what I think anyone had anticipated. The noble Lord, Lord Darzi—this relates to the point that the noble Lord, Lord Scriven, made about evidence—traced the current crisis back to the 2012 top-down reorganisation of the NHS and the establishment of NHSE. He stated that it had

“imprisoned more than a million NHS staff in a broken system”.

There are twice as many staff working in NHS England and the Department of Health and Social Care today as there were in 2010. In 2010, the NHS was delivering the shortest waiting times and the highest patient satisfaction in history. When we came into government last year, it was the exact opposite: the longest waiting times and the lowest patient satisfaction in history.

You can add that up: taxpayers pay more, and they get less. We have been left with two very large organisations. I see that there are some former Ministers from the department in the Chamber today, which I am glad about. I will not speak for them, but they might also reflect that they will have noticed duplication and layers of bureaucracy that have stifled the progress and the patient treatment, patient focus and patient experience that we all seek to improve. The noble Lord, Lord Kamall, talked about the need for us all to coalesce around the interests of the patient, with which I certainly agree. Over the next two years, the intention is to bring NHS England into the department entirely. That will make significant savings of millions of pounds a year. To noble Lords who have raised some questions about whether the money will flow down to the front line, I say that it will cut waiting times faster and deliver our plan for change.

The matter of staff came up, and I will come back to that. I acknowledge that there are talented, committed public servants who work at every single level of the NHS and the Department of Health and Social Care, including NHS England, with whom I have had the privilege of working over the past eight months under this Government. I was previously a Minister in the department in the last Labour Government. This is about the system, not the people. I say that to reassure those who are employed both at the department and in NHS England.

The noble Lord, Lord Scriven, asked some important questions about staff reductions and when redundancies would potentially take place. There are currently 19,000 staff across NHS England and DHSC; across both, we are looking to reduce the overall headcount by 50%. Conversations have already begun with the trade unions on this change, and we will of course continue to engage with them throughout the process. As the noble Lord, Lord Scriven, rightly observes, abolishing NHSE—a non-departmental public body—will require primary legislation, so we are working with the usual channels to ensure that we have an appropriate legislative timetable to allow us to do things in a timely way, while safeguarding what is an ambitious legislative programme that has already been set out. We are already getting on with the job immediately, which also answers the point raised by the noble Lord, Lord Scriven, about bringing NHSE back into the department.

The noble Lord, Lord Kamall, raised a very good point about the need for better understanding, clear lines and transparency. One of my learnings since we announced the abolition of NHSE was that, unfortunately, some members of the public thought that meant we were abolishing the NHS. I would like to reassure anybody in this Chamber or outside it that we are not doing that at all: we are committed to the National Health Service, as we have always been throughout our history as a party, and we will continue to strengthen it. However, what that said to me relates to the point the noble Lord made. People do not care about structures, and why should they? What they are interested in—and I completely endorse this—is what it does for them. Can they get that appointment? Can they get that treatment? Can their child get access to dentistry, or whatever it is? That is what people want.

Actually, this is a tremendous opportunity to be clearer and more straightforward about what those lines are, and I certainly look forward to doing so. The noble Lord, Lord Kamall, is right about the need for a change in culture, and I think that applies to a whole range of issues.

This measure has been considered and, as I explained, was born through experience and evidence. It will fit as part of the 10-year plan, to which the noble Lord, Lord Kamall, referred, and I thank him for that. On when that will be published, I will say only that I hope the noble Lord will not feel he is kept waiting for much longer. I am very grateful to everybody who gave input to the consultation—the biggest one ever in the history of the NHS.

The noble Lord, Lord Scriven, rightly asked for a number of details about impact; there will, of course, be a full impact assessment with the legislation. He asked particularly about improvements overall, which is what we seek. Currently we have two organisations, many layers and duplication. I cannot think of one organisation that can boast all that—I do not say boast in a positive way—and say it is at its most efficient in delivering for whoever the service users are.

All of it will translate to improvements on the front line, which is what we are talking about. As I mentioned, as I often do, earlier in Questions, we believe that decision-making locally—done in the interests of the local population, with their involvement and reflecting their nature—is crucial. Noble Lords will be aware that, on the advice of the report by the noble Lord, Lord Darzi, we reduced the numbers of targets in the planning guidance from 32 to 18, to free up local areas to better meet the local requirements. Again, we see the direction of travel.

The noble Lord, Lord Scriven, asked about senior management and severance packages. Of course, I cannot comment on individuals, but I emphasise that, in the cases of those who announced their resignation, it was just that, so all the normal arrangements would apply.

I hope we can continue to work together to improve the structure, support the staff and, most importantly, keep patients at the centre, so that they see improvements from this change and the recognition that two organisations are duplication and this needs to change.

--- Later in debate ---

[Baroness Thornton (Lab)]

I am just asking the question. What is the likely timescale for when investment might be released? I am thinking particularly about technology and investment in infrastructure, as a non-executive director of a hospital, a large part of which is still a Victorian build.

[Baroness Merron (Lab)]

I thank my noble friend for her reflections on what has gone before and her welcome that the opposition parties can work with us to put this into a better place now. With respect to change and productivity, and a further extension to the point raised by the noble Lord, Lord Kamall, about culture, I can say straightaway that the Government have a 2% productivity growth target in 2025-26. That is immediate. We are not waiting to make this change, because if we do not improve NHS productivity and efficiency, we will not be able to deliver the three shifts needed to future-proof the NHS and support the Government’s growth mission.

We have already invested more than £2 billion in NHS technology and digital in 2025-26, which will help with essential services and drive productivity in hospitals, such as the one that I know my noble friend serves very well. That will free up staff time, ensure that all trusts have electronic patient records, improve cybersecurity and enhance patient access through the NHS app. That is before we even make this change.

We have already achieved a lot in the past eight months, but that is why we have to continue with this reform. We have delivered the 2 million extra appointments that we promised, months ahead of schedule, we have cut waiting lists by 193,000, and, as I said earlier, we have committed to 700,000 extra urgent dental appointments, just to name some. We know about the importance of change, which the noble Lord, Lord Scriven, asked me about, and that my noble friend calls for. That is why we will always continue to take bold steps where we have to, and not shy away.

[Baroness Bottomley of Nettlestone (Con)]

My Lords, the point is well made about duplication, bureaucracy and excessive cost. Can the Minister give us an assurance, though, that we will not move from excessive bureaucratic centralisation to political centralisation? There are few politicians who are clinicians, sophisticated managers or financiers. This is the largest employer in the world, with extraordinarily dedicated and talented individuals concerned. They will not be happy to think that they will be organised on the whim of whoever is the latest Minister.

The right reverend Prelate the Bishop of London used to be the Chief Nursing Officer—there are many people who have worked at high levels in the NHS. We need to be confident that there will be an evidence-based, rational system at some distance from party-political considerations, because the viciousness of health debates about hospital closures, boundaries and other matters knows no bounds. We do not want by-elections to become involved in non-party-political matters.

The noble Lord, Lord Waldegrave, and even the noble Lord, Lord Clarke, and I, were very happy with an NHS executive which was part of the department. However, the role of the chief executive was not the same as the role of the Secretary of State. I hope the Minister can give us some assurance.

[Baroness Merron (Lab)]

I am very pleased to give the reassurance that the noble Baroness seeks. When we reflect, the disastrous 2012 top-down reorganisation certainly did not depoliticise the NHS—it made it less efficient and less able to treat patients on time.

This is not about politicisation; this is about responsible government. I add—without embarrassing anybody—that a number of former Conservative Health Ministers have said to me, and to my colleague Ministers and the Secretary of State, how much they welcome this and how they wish that they had taken this step. That, for me, as well as the tone of the contributions from the Front Benches today, provides the reassurance the noble Baroness seeks.

[Lord Kakkar (CB)]

My Lords, I draw the House’s attention to my registered interest as chairman of King’s Health Partners. In the announcement made by the right honourable Secretary of State for Health in the other place, there was particular emphasis on identifying that in this period of transition, NHS England will focus on ensuring that local providers are better able to cut waiting times and to organise their finances appropriately. But NHS England has many other functions beyond those two important ones, and they will need to be delivered in what is a substantial transformation in reabsorbing NHS England into the Department of Health and Social Care. What reassurance can the Minister give your Lordships’ House that functions such as the recently integrated Health Education England function into NHS England, the NHS Digital function and many others, are going to be properly supervised and delivered during this period? They are as essential, in many ways, as delivering on waiting times and organising finances.

[Baroness Merron (Lab)]

The noble Lord is right to talk about NHS England in all its functions. Bringing it together with the department will not diminish those functions but will allow them to be delivered rather more effectively than they are currently. At the head of the transformation team is Sir James Mackey, the new chief executive of NHS England, working with Dr Penny Dash as chair. Both individuals are well respected across the sector for their outstanding track records, not least on turning round NHS organisations, in Jim’s case, but also on balancing the books, driving up productivity and driving down waiting times—exactly what is needed. But I agree totally with the noble Lord, and we are going to ensure that the necessary functions are continued; it is the way they are delivered that we are changing.

[The Lord Bishop of London]

My Lords, I declare my interest as indicated by the noble Baroness, in that I am a former government Chief Nursing Officer. Following on from the noble Lord’s point, this is a very significant change not just to the NHS but to its workforce. We know from looking back that when there is a reorganisation of the NHS, attention and funds are distracted away from the front line and patient care. The announcement came on the same day as the publication of the NHS staff survey results, which highlighted that only 31% felt that there were enough staff to enable them to do their job, and that 45% felt unwell due to work-related stress. What action will the Government take to make sure that there is not a management distraction, through this reorganisation, away from the front line and patient care in particular? How will staff be supported during this transition, not least those who, I suspect, fear that their jobs are now under threat?

[Baroness Merron (Lab)]

I recognise what the right reverend Prelate is saying. I myself have experienced change in large organisations, and change is never easy. We are talking about job losses; we cannot shy away from that. But it is appropriate that I re-emphasise the reassurance of our respect for and thanks to all those talented and hard-working staff in both the department and NHSE. We will, as I said, work with trade unions on this change in order to be fair and transparent and to deal with it properly. Of course it is uncomfortable, and people naturally find it difficult.

It is also important to look at the benefits. Currently, we have rather too much micromanagement, which frustrates progress and staff. Reducing that is one of the liberations that this will provide, so we can innovate and get on with caring for patients.

On maintaining people’s morale, this is a big challenge for us because morale has not been good at all, so we will pay particular attention to this as we publish the workforce plan later in the summer. This work continues. Senior managers and transformation team are very alive to the points the right reverend Prelate has made, and they will continue in that regard.

[Baroness in Waiting/Government Whip (Baroness Blake of Leeds) (Lab)]

My Lords, I am very conscious that a number of noble Lords want to get in. Can all keep their questions brief? I will take the Liberal Democrat contribution first and then Labour.

[Baroness Tyler of Enfield (LD)]

My Lords, I will be brief. With such a strong emphasis in the Statement on reducing duplication and bureaucracy, can the Minister say what consideration is being given to fusing NHS England’s regional offices with the remaining ICBs that come within their geographical area? It strikes me that there is scope for savings there.

[Baroness Merron (Lab)]

All of this will be looked at by the transformation team, because it is a considerable change. I thank the noble Baroness for that contribution, and I will ensure that it is heard.

[Baroness Rafferty (Lab)]

My Lords, can my noble friend the Minister kindly confirm that the role of the Chief Nursing Officer for England will migrate to DHSC?

[Baroness Merron (Lab)]

My noble friend will know—as I am sure the right reverend Prelate knows—that the Chief Nursing Officer has always played a role in advising Ministers; that the case was long before the establishment of NHS England and will continue long afterwards. The chief executive, Sir James, has announced his new transformation team, and that includes NHS England’s Chief Nursing Officer.

[Lord Markham (Con)]

As a former Health Minister, I too welcome this move, but the devil is in the detail. The point made about the NHS regions is completely right: that is another layer which will stop hospitals being freed up in the way the Secretary of State said he wants to happen. There is the question of whether lots of merged entities will be demerged again. As we all know, it is the uncertainty which hits productivity in the meantime, when people are naturally worried about their jobs.

I would really like to press the Minister on when we will see the detail behind the plan. When will it be produced, and when can we give the staff the information they need, so they know their position? Until that happens, the uncertainty will, unfortunately, hinder productivity and stop the changes we all want to see happening.

[Baroness Merron (Lab)]

I understand that point and the noble Lord’s wish for dates, which I am not able to give him, as I am sure he will appreciate. These reforms are not about front-line staff losing their jobs; we are talking about people employed directly by the department and the NHS. The noble Lord referred to the Secretary of State, and I would add that other arm’s-length bodies also need to be leaner than they are today.

I understand the problem, and we are going to work very closely with staff organisations, but it is not a neutral situation. Staff are suffering from box-ticking, duplication and red tape, which prevents them doing their job properly. Their morale is not good in this case—in any case. We do not want to add to that, but we do want to give them hope for the future.

[Baroness Butler-Sloss (CB)]

After the transformation team has completed its work, who will take over the duties that the noble Lord, Lord Kakkar, referred to in his question?

[Baroness Merron (Lab)]

That will be declared in due course, once the work has been completed.

[Baroness Sugg (Con)]

My Lords, I spent yesterday morning at the women’s health department in Mile End hospital—I know the Minister is a great champion, and I highly recommend a visit. What will the NHS England update mean for the women’s health strategy, and, specifically, for NHS England’s commitment to eliminating cervical cancer by 2040?

--- Later in debate ---

[Baroness Merron (Lab)]

It will not affect commitments to women’s health. As we have said, women’s health remains a priority. The noble Baroness will know that there are some 600,000 women already on the gynaecology waiting list; that is far too long for women to wait. Women’s health hubs are part of the solution, and I continue to champion those with the integrated care boards.

[Lord Turnberg (Lab)]

My Lords, I am delighted to support the direction of travel towards patients first. I wonder if there are savings to be made. We can concentrate on the gap in social care, where I suspect much of the NHS is so interdependent. Social care is so badly funded, and we need to do something there.

[Baroness Merron (Lab)]

As we discussed earlier, the provision of social care and housing has a huge impact on quality of life and discharge from hospital. As my noble friend will be aware, the noble Baroness, Lady Casey, will be commencing her look into social care, to report to us all on the immediate and long-term changes that are needed and to build cross-party consensus.

[Baroness Freeman of Steventon (CB)]

My Lords, since NHS Digital was merged with NHS England, NHS England staff have been running absolutely critical data and digital infrastructure. During this period of uncertainty, we are bound to be in danger of losing some staff with expertise that is difficult to replace. What are the Government doing to make sure that these jobs are absolutely safeguarded and that this expertise is not lost?

[Baroness Merron (Lab)]

Nobody should worry about data or their privacy. Our job is to improve our ability on data, and this change will not affect that. Indeed, part of the 10-year plan will include a move from analogue to digital, because we recognise the importance of data and digital change in improving healthcare. This change will give us a better opportunity to implement that.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I congratulate the Government on removing a powerful and unelected body—the world’s largest quango. What the Government have done is so important democratically, given that the Secretary of State says, “The buck stops here”. However, it is not a silver bullet. There is no NHS England in Wales—my neck of the woods—and the buck stops with the Senedd, but the Welsh health service is in a terrible state, with wastage of money, red tape, bureaucracy, and smoke and mirrors about where money is being spent. Does the Minister agree that that can happen even when the buck, apparently, stops with the politicians?

[Baroness Merron (Lab)]

I am not sure if that was a question about politicians or Wales. We work very closely with the devolved Governments, as the noble Baroness will be aware. On her point about politicians, we take our responsibilities very seriously. That is why we have recognised the problem and are acting.

Safe Housing and Hospital Discharge

Baroness Merron Excerpts

Wednesday 19th March 2025 Lords Chamber

[Baroness Thornhill]

To ask His Majesty’s Government what steps they are taking to improve collaboration between integrated care boards and housing providers to address barriers to safe housing and support timely hospital discharge.

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

My Lords, the Government recognise that the availability of safe housing contributes to timely and effective hospital discharge. We published a new policy framework for the £9 billion better care fund in January. Integrated care boards and local authorities have to work together, with involvement from local housing authorities, to agree joint plans to deliver joined-up care. The £86 million uplift to the disabled facilities grant this year can provide around 7,800 additional home adaptations.

[Baroness Thornhill (LD)]

I thank the Minister for her Answer and welcome what she has said. It is absolutely clear now that the lack of supported housing is a major factor in delayed discharge from hospital and that integrated care boards are part of the solution. Can the Minister explain why, only last week, the Government made the shock announcement of a 50% cut to the core funding to these very boards? Surely they should be integral to creating solutions to this costly, damaging and seemingly intractable problem.

[Baroness Merron (Lab)]

As the noble Baroness will be aware, this Government want to see provision and decision-making directed by local leaders. She and the House will be aware of the financial situation which we have inherited. I reiterate what I said about the £9 billion committed to the better care fund, which includes £5.6 billion to integrated care boards and around £3.3 billion to local authorities.

[Baroness Warwick of Undercliffe (Lab)]

My Lords, 73% of delayed discharges from mental health hospitals are due to a lack of appropriate supported housing step-down services. With bed occupancy rates of 94%, the increasing pressure is driving up the inappropriate use of out-of-area placements. What plans do the Government have to ensure that there is enough supported housing to meet the demand for step-down services?

[Baroness Merron (Lab)]

My noble friend made particular reference to mental health care. She will be aware of the discussions that took place at Second Reading and in Committee on the Mental Health Bill. I am sure we can all agree that an out-of-area placement is not ideal, although there are some circumstances in which it has to be the case. In the progress of that Bill, we will be attending to the point that she makes. I agree with her that the delays attributed to housing are significantly higher, at 17% for patients who are discharged from mental health settings. This remains a challenge that we are focused on.

[Lord Best (CB)]

My Lords, has the Minister considered the proposal from the Centre for Ageing Better for good home hubs, where older people whose homes are inaccessible, cold and unsafe can get all the advice and support they need on adaptations that can make such a difference—the stairlift, the walk-in shower, better insulation—thereby enabling them to live longer independently and to take the pressure off the NHS and care services?

[Baroness Merron (Lab)]

The noble Lord puts the case strongly for the process of home adaptations. As I have already mentioned, we have provided an immediate in-year uplift to the disabled facilities grants of some £86 million, which will enable people to adapt their homes exactly in the way that the Centre for Ageing Better describes, and I welcome its work. I should say that it is the responsibility of local authorities to ensure that they are supporting applicants through the process of home adaptations as much as possible. We are always looking at ways to improve the process and share good practice, so I welcome the contribution of the Centre for Ageing Better.

[Lord Blunkett (Lab)]

Will my noble friend confirm that very few integrated care boards are either integrated or about care? Much of the work that should be going on is going on with health and well-being boards, which are a combination at place level of the relevant local authority and the health service at the point where delivery takes place.

[Baroness Merron (Lab)]

My noble friend has given me an invitation to agree with him. As he knows, it would be quite inappropriate to suggest that integrated care boards are not integrated or about care—that is their focus—but I appreciate his view on the matter. I do agree with him that much good work is done on the health and well-being boards. This all says to me that local decision-making, and local provision for local populations with their particular dimensions and demands, is the best way forward. My final point on this question is that local systems have to agree plans to achieve more timely and effective discharge from hospital, and to work with local authorities to develop those plans.

[Lord Kamall (Con)]

My Lords, NHS data from last month revealed that there are about 13,800 people who are medically fit for discharge, which is up from 12,000 patients awaiting discharge on 1 December. As other noble Lords have said, we know that that causes a bottleneck in hospitals that is not good for patients while they wait to go home. As has been said, one way to reduce that bottleneck is the greater use of virtual wards, allowing people to stay in their home for longer, to be monitored in their home and to receive care. The Minister has answered this question to a certain extent, but can she tell us more about the Government’s overall plan for virtual wards, not just in this case but for physical and mental health care, in order to ensure that we can get more patients out of hospital beds and into their homes, where they can receive the care they deserve and be constantly monitored?

[Baroness Merron (Lab)]

I am glad that the noble Lord shares my enthusiasm for virtual wards. I shall expand on what they are: they allow people to be not in hospital but in their own home, whether it is their personal home or whether their home happens to be in a care home or some other setting, by the use of technology that allows them to be monitored. I recently saw an excellent example of that, and the liberation that it provides for individuals who would much rather not be in hospital is key. The noble Lord will know that, in the 10-year plan, the move from hospital to community is a key pillar, and we will soon be reporting on that. I certainly share his enthusiasm.

[The Lord Bishop of London]

My Lords, the VCSE sector plays a critical role in discharge planning. The Minister may know of a project in Warrington, where a social prescribing link worker and the VCSE team are integrated into the discharge team, and are therefore able to support people on discharge. The pilot has been positive, not least in that it has reduced readmission into hospital. Could the Minister say what support the Government are giving to integrated care boards so that they can enable this type of innovative provision? Can she reassure us that the aspiration to cut the ICBs by 50% will not impact on that potential?

[Baroness Merron (Lab)]

I very much commend the innovation and the commitment of people locally in the way that the right reverend Prelate describes. ICBs would be wise to work closely with the third sector in order to provide support and to tackle the very real challenges. With regard to decisions on how they use their funding, it is for ICBs to take into account the needs of the population and provide accordingly. As I say, it would be a wise ICB that took advantage of the innovation and the commitment in its local area.

[Baroness Tyler of Enfield (LD)]

My Lords, does the Minister think that there is a case for further guidance or even legislative change to ensure that ICBs—those left standing anyway—are actively improving integration between the NHS and other stakeholders, such as housing and local government? We all understand that social care is vital to successful discharge plans. Is the Minister able to say how many ICBs have senior representation from social care or local government on their boards?

[Baroness Merron (Lab)]

As the noble Baroness is aware, ICBs bring together local government and local health services. While I cannot be as specific as the noble Baroness asks, I will be very happy to look into that. There is not just an expectation but a requirement, as I said, to agree plans locally, which means more timely and more effective discharge. Certainly, the better care fund is crucial, so I feel that we are going in the right direction. This is a matter that we constantly have under review, and we are always looking for ways to improve delivery.

Soft Drinks Industry Levy

Baroness Merron Excerpts

Tuesday 18th March 2025 Lords Chamber

[Lord Rennard]

To ask His Majesty’s Government what assessment they have made of the success of the Soft Drinks Industry Levy in comparison to voluntary sugar, salt and calorie reduction and reformulation measures.

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

My Lords, the soft drinks industry levy has nearly halved the sugar in soft drinks. By uprating the levy, as was announced in the Budget, we will ensure it remains fit for purpose and drives further restrictions. The voluntary programme has delivered meaningful product change and learning on what more is possible. We continue to drive reformulation through promotion and advertising restrictions, which are showing promising results. We will continue this momentum to create a healthier generation.

[Lord Rennard (LD)]

My Lords, the levy has reduced considerably the number of children who would otherwise have been admitted to hospital for dental extractions. Two-thirds of the public support an expansion of the principle of this levy to other high-sugar foods, with revenue raised funding children’s health programmes. Will the Minister commit to supporting the Recipe for Change campaign, which is backed by over 50 health charities and medical colleges, given that if the proposed sugar and salt levy in Henry Dimbleby’s National Food Strategy was implemented it could avoid more than 320,000 cases of type 2 diabetes over the next 25 years?

[Baroness Merron (Lab)]

I understand why the noble Lord raises this: he, like me, wishes to reduce obesity rates. Although the soft drinks industry levy is showing success, it is much harder, as he will be aware, to apply the same in respect of food, simply because of its formulation: there is no other sugar in soft drinks beforehand, whereas there is in food. Although I understand the pressure to do this, and we continue to do more, it is not quite as straightforward to draw the direct comparisons, as I know he understands.

[Lord Rooker (Lab)]

I remind my noble friend that the voluntary system for the reduction of salt, which was organised by the Food Standards Agency before I joined it, was so successful that the World Health Organization held its international conference in London in 2010 because it had been so successful on a voluntary basis. Of course, this was before the noble Lord, Lord Lansley, removed nutrition from the Food Standards Agency. The voluntary system can work substantially.

[Baroness Merron (Lab)]

My noble friend is right: voluntary schemes can indeed work well. In addition to crediting my noble friend for his work with the Food Standards Agency, I can tell your Lordships’ House that voluntary reformulation has encouraged sugar reduction by around 15% in cereals, 13% in yoghurts and 29% in milk-based drinks, and contributed to a reduction in salt intake. Of course more can be done to improve everyday food and drink, and we continue to work by whatever means necessary and within all sectors of industry to do just that.

[Baroness Manzoor (Con)]

My Lords, the Minister will know that sugar has been substituted with glycerol in slushy drinks—these are iced drinks that are particularly for children. This is having an adverse health impact, particularly on young children. According to recent press announcements, a number have been admitted to hospital. Can the Minister say what the Government are doing to educate parents and to address this issue?

[Baroness Merron (Lab)]

I thank the noble Baroness for raising this very important point. The Food Standards Agency is considering very carefully the findings of the review mentioned in the media, to which she referred. In the meantime, parents are strongly encouraged to follow the advice that slushy drinks should not be given to children under four years old. Retailers are also advised to make adults fully aware of this guidance if they seek to buy them for children. In addition, although the symptoms of intake are usually mild, it is important that parents are aware of the risks, particularly at high levels of consumption. I thank the noble Baroness for shining a light on this matter.

[Baroness Bennett of Manor Castle (GP)]

My Lords, research by the First Steps Nutrition Trust shows that parents believe that baby foods are strongly regulated. In fact, there is no legal threshold for the amount of sugar in baby foods in the UK; there is only a threshold for the amount of added sugar. If a large quantity of concentrated fruit juice is added, we end up with baby foods that have implicit labels on them suggesting that they are healthy but they contain more sugar than Coca-Cola. In the UK, 61% of two to five year-olds’ energy comes from ultra-processed foods. Will the Government look to get significant, important regulation for baby foods?

[Baroness Merron (Lab)]

I understand the point that the noble Baroness raises. This is one of the areas that we are looking at. She also raised ultra-processed foods. As she may be aware, the Scientific Advisory Committee on Nutrition has reviewed evidence and stated that further research is needed as to whether ultra-processed foods are unhealthy due to processing or to an unhealthy nutrient content. We have discovered that we need to separate the two. That will also assist on the point that she raised about baby foods.

[Lord Kamall (Con)]

My Lords, although sugar taxes and levies are examples of top-down state solutions to tackle obesity, I will ask the Minister about grass-roots, bottom-up solutions. She will know of non-state local civil society projects that work in communities to encourage healthier lifestyles, such as BRITE Box in south London, which offers recipes, ingredients and budgeting advice to help low-income families cook and eat more healthily. Can she tell your Lordships how the department works with such local projects to tackle obesity and how that best practice has spread to other communities? Could she also write to me with a list of some of the projects that her department is aware of, so that all noble Lords could learn a bit more?

[Baroness Merron (Lab)]

I would be very pleased to write further to the noble Lord on this matter. I pay tribute to all of those community third sector organisations that work in line with government direction to reduce obesity. There are many aspects to this: it is not just about what community organisations can do but, for example, about implementing TV and online advertising restrictions for less healthy food. In all these ways, we will be able to make progress to reduce obesity.

[The Lord Bishop of London]

My Lords, we know well that diet and nutrition, and the infrastructure from which we can access the food that we eat, determine our health. These things continue to be unequal. The proportion of household income required to afford to follow the Eatwell Guide is 11% in the least deprived areas and 45% in the most deprived areas. What consideration will be given in the NHS plan to these wider issues—including the merits of reformulation policies—to improve the critical determinants of health?

[Baroness Merron (Lab)]

The right reverend Prelate is right to speak about the additional levels of ill health and obesity; a child of 11 in the most deprived areas is twice as likely to be obese as those in the least deprived areas. I can certainly assure her that the 10-year plan, which is soon to be made available, will take account of inequalities in all their aspects, including nutrition and food.

[Lord Bird (CB)]

Is the Minister aware that, according to the BMA, 50% of people who suffer from cardiac arrest actually suffer from food poverty in the first instance?

[Baroness Merron (Lab)]

I thank the noble Lord for that point. He will know that the Defra-led food strategy will assist us across government in tackling this.

[Baroness Walmsley (LD)]

My Lords, I will follow up on the question from the noble Baroness, Lady Bennett of Manor Castle, about the regulation of foods for babies and toddlers. Is the Minister aware that some of the fruit and vegetable pouches marketed for babies from four months onwards—despite the advice that they should not be weaned until they are six months old—contain more sugar per 100 millilitres than Coca-Cola? Some toddlers’ teeth are being rotted as they emerge from their gums. When will the Minister take action on this?

--- Later in debate ---

[Baroness Merron (Lab)]

The noble Baroness reminds us that one of the major causes of children having to report to A&E is dental decay. That is why I am glad that we have announced plans for over 700,000 urgent dental appointments, as well as for supervised tooth-brushing. To the specific point that the noble Baroness makes, she is indeed right about the progress that needs to be made. We have recently responded to the House of Lords Select Committee inquiry into food, diet and obesity, as I know she is well aware. We will have a debate on that formal response on 28 March.