Mental Health Bill [HL]
Baroness Merron Excerpts(1 day, 9 hours ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, I will make a brief statement on the devolution status of the Bill. The majority of the Act that the Bill amends extends to England and Wales. An initial legislative consent memorandum was laid in the Senedd following the Bill’s introduction. Following further amendments to the Bill, supplementary legislative consent memorandums have been laid. I thank the Welsh Government for their constructive engagement, and I am pleased that they are recommending consent. The Senedd will hold a vote on legislative consent before the end of the Bill’s passage through Parliament.
Clause 30: Periods for tribunal applications
Amendment
Baroness Merron
“(c) in paragraph (e), for “six months” substitute “three months”.”Member's explanatory statement
This amendment is consequential on clause 29(2) of the Bill and changes the period within which an application to the tribunal may be made where a patient is transferred from guardianship to a hospital to align that period with the initial detention period in relation to the patient.
Baroness Merron (Lab)
My Lords, this is a minor and technical amendment which would reduce from six months to three months the period within which an application to the tribunal may be made, where a patient is transferred from guardianship to a hospital under Section 19.
We are making this change to ensure that the relevant period within which transferred guardianship patients can make an application to the tribunal aligns with the relevant period for Section 3 patients. This is consequential to the changes that the Bill makes in Clause 29 to reduce from six months to three months the initial detention period for patients admitted for treatment, as part of our intention to provide patients with faster access to tribunals to review relevant decisions about their care. I beg to move.
Baroness Merron (Lab)
My Lords, it has been an extraordinary honour and pleasure to take this Bill through the House with my noble friend Lord Timpson. As we are all aware, numerous aspects of the Mental Health Act 1983 are not serving us today. Over the decades, we have seen racial inequalities, inadequate care for individuals with learning disabilities and autism, and insufficient empowerment of patients who have not had an adequate voice.
Reform to the Mental Health Act is therefore long overdue. Many of the processes in the Act are out of step with a modern mental health system and with society at large. It has been a privilege to advance these reforms to deliver the Government’s manifesto commitment to modernise the Act to give patients greater choice, autonomy, enhanced rights and support, and to ensure that everyone is treated with dignity and respect throughout treatment, while ensuring that patient and public safety is paramount.
As noble Lords will be aware, this Bill is the product of the combined effort, over many years, by Members of both Houses and many outside Parliament who have worked for change and to whom thanks are due. I express my sincere gratitude to members of the former Joint Committee on the Draft Mental Health Bill: the noble Baroness, Lady Buscombe, as chair, as well as my noble friends Lord Bradley and Lady McIntosh of Hudnall, and the noble Baronesses, Lady Barker, Lady Berridge and Lady Hollins. The work and careful consideration that went into their rigorous scrutiny of the draft Bill, along with the constructive recommendations made, have undoubtedly strengthened it.
I pay tribute to the former Prime Minister, the noble Baroness, Lady May, who identified the need for modernisation and set up the independent review of the Act in 2017, chaired by Sir Simon Wessely and supported by the noble Baroness, Lady Neuberger, as one of the vice-chairs. Without this, we would not be here today.
I extend my heartfelt thanks to all Peers who have engaged with the Bill’s reforms. In addition to those previously mentioned, gratitude is due to both Front Benches—to the noble Lord, Lord Kamall, the noble Earl, Lord Howe, the noble Lord, Lord Scriven, and the noble Baroness, Lady Tyler. I am grateful to all noble Lords from across the House who have spoken during the various stages of the Bill and engaged with me and my officials over the past few months.
Because I would like to think that I am wise, I also thank my Whip, my noble friend Lady Blake, and my previous Whip, my noble friend Lord Cryer. I thank the Chief Whip and the whole of the Whips’ team and the team in the Leader’s office, including Ayeesha Bhutta and Michael Bleakley. My appreciation, as ever, goes to the clerks, doorkeepers and staff of the House.
I extend my heartfelt gratitude to all the officials who have played a crucial role in the progression of this Bill, and hope your Lordships’ House will indulge me while I give them the honour of mentioning them by name, because I believe they deserve it. Special thanks go to Phillip Dunkley, our Bill manager, and his dedicated team, Callie Mulligan, Sam Monday, Emily Bouldero and Rhys Jose. I am deeply appreciative of the Bill’s senior responsible owners, Kathy Smethurst and Caroline Allnutt, as well as the DHSC officials, including Esther Horner, Hannah Coaker, Alice Devlin, Matt Siddons, Tabitha Mufti, David Nuttall, Jennifer Rhodes, Megan McIvor and Mihiri Seneviratne, and their teams.
Additionally, I want to acknowledge the invaluable contributions of the Government Legal Department officials, Matt Smith, Lizzie Rattee, Nicky Richardson and Tim Spencer Lane, and their wider team, along with my private office staff, including Carl Plane and Yetunde Agaga, as well as Diggory Bailey and Victoria Griggs from the Office of the Parliamentary Counsel.
While I cannot list every individual, I express my appreciation to all officials who have played a part, including officials from the Ministry of Justice. Their unwavering support and dedication have been instrumental in the successful advancement of the Bill, and their work with Peers—as noble Lords across the House will testify—has been exemplary. I am confident that this legislation will make the Mental Health Act fit for the 21st century and give greater and better support to people when they need it. I look forward to it receiving support in the other place. I beg to move.
Lord Kamall (Con)
My Lords, as the Minister has said, debating the passage of the Bill through your Lordships’ House has been a pleasure. We have seen a genuine spirit of constructive engagement with a Bill that we all acknowledge will help patients who encounter mental health services, as well as a cross-party desire to improve the Bill. This was not a particularly political Bill; we found alliances across political lines and did not play political games. We wanted to improve the Bill and make sure that patients receive the best possible care. That is a wonderful demonstration of the value of this House.
I extend my thanks to all Peers who took part. I also thank the members of the pre-legislative committee whom the Minister acknowledged. Like the Minister, I acknowledge my noble friend Lady May of Maidenhead, the former Prime Minister, who we have to thank for beginning the process that led to this Bill. My noble friend identified the issue of racial disparities in the use of community treatment orders and wanted to reduce the involvement of police where they are not needed. Even though my noble friend was unable to be in her place to speak to her amendments on Report, I am grateful to all noble Lords who supported them, and I am delighted that the House has decided that they should be inserted into the Bill. We look forward to how that will be debated in the other place.
It was also welcome to see the House rally behind my noble friend Lady Berridge’s amendment to ensure that the process for appointing nominated persons for patients under 16 aligns with the Children Act 1989. My noble friend was crystal clear that there has to be consistency between different Bills, and that we do not want people falling between Bills and into harm’s way. She highlighted this and gave some harrowing examples of what could happen if we do not align these Bills. We have to make sure that we align them as much as possible.
I also thank the noble Lord, Lord Scriven, and the noble Baroness, Lady Tyler, for their dedication to improving community treatment orders and addressing racial disparities. Noble Lords will remember that this is probably the issue that was closest to my heart, and we probed the Government heavily on it. There are still too many racial disparities. We understand that it is a complicated issue, but the Government assured the House that they are looking into the data around this. What do they know? What do they not know? How will they fill that gap and what will they do to address racial disparities? I hope that is something that all noble Lords can agree on.
Of course, I have to thank my noble friend Lord Howe for his stalwart support and advice on this Bill, and for his experience not only of parliamentary procedure but of previous iterations of this Bill. I appreciate his sagacity, and I am grateful whenever he agrees to work with me on Bills—sometimes to curb my schoolboy enthusiasm and keep me on the right path. I am grateful that he has agreed to work with me on the Tobacco and Vapes Bill, which your Lordships will debate later today.
I also thank the Minister—and of course her noble friend, the noble Lord, Lord Timpson—for taking time at the Dispatch Box, and for the fact that the Minister and her officials were always available to meet us to try to iron out some of the disagreements or find compromises. That is very much appreciated by all noble Lords in this House. I thank Ben, the special adviser in her office, for his input, and, in our office, our adviser Jamie Tucker, who was amazing in his understanding of the Bill.
I will end by mentioning a quote that was sent to me and my noble friend Lord Howe from the charity Blooming Change. On hearing that the House had voted in favour of my noble friend’s amendment on mandatory debriefing for mental health patients, a younger person told the charity:
“I genuinely for the longest time felt like I didn’t matter, to anyone or anything, that the universe didn’t need to hear my voice, that what I went through didn’t matter. It took so long to build my confidence and to find my voice … I’m glad I decided to use my experiences to fight for change and I’m so happy our words have made a difference. We will keep fighting for more changes, little by little”.
As the Bill now progresses to the other place, I hope all Members involved will heed those wise words.
Tobacco and Vapes Bill
Baroness Merron Excerpts(1 day, 9 hours ago)
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Baroness Merron
That the Bill be committed to a Committee of the Whole House, and that it be an instruction to the Committee of the Whole House that they consider the Bill in the following order:
Clauses 1 to 16, Schedule 1, Clauses 17 and 18, Schedule 2, Clause 19, Schedule 3, Clauses 20 and 21, Schedule 4, Clauses 22 to 40, Schedule 5, Clause 41, Schedules 6 and 7, Clauses 42 to 64, Schedule 8, Clause 65, Schedule 9, Clauses 66 to 83, Schedule 10, Clause 84, Schedules 11 to 13, Clause 85 and 86, Schedule 14 and 15, Clauses 87 to 126, Schedule 16, Clauses 127 to 140, Schedule 17, Clauses 141 to 145, Schedule 18, Clauses 146 to 151, Schedule 19, Clauses 152 to 156, Schedule 20, Clauses 157 to 159, Schedule 21, Clauses 160 to 170, Title.
Tobacco and Vapes Bill
Baroness Merron Excerpts(1 day, 9 hours ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, I beg to move that the Bill be now read a second time, and it is an honour to do so.
The evidence, despite perhaps some lingering myths and misperceptions, remains stark and compelling: smoking remains unequivocally the number one preventable cause of death, disability and ill health in our nation. Progress has been made, but this is not a problem of the past. Smoking continues to cast a long shadow over our society, remaining a significant public health challenge with persistent rates of prevalence. Every year we witness the loss of approximately 80,000 lives in the UK directly attributed to smoking.
The impact of smoking reverberates throughout lifetimes, increasing the risk of a whole range of conditions from stillbirth through to significantly higher rates of dementia, stroke, heart attacks, lung diseases and many cancers. Smoking also results in a significant loss of productivity in the wider economy and places a considerable burden on our healthcare system. In total it is estimated to cost society approximately £21.3 billion annually.
To correct this course, this Bill will create a smoke-free generation, making it an offence to sell tobacco products to anyone born on or after 1 January 2009, meaning those who turn 16 this year, and younger, will never legally be sold tobacco in the UK. This will gradually end the sale of tobacco products across the country, protecting future generations from the well-documented and evidenced harms of smoking.
In turning our attention to vaping, we face a nuanced challenge. Vapes are less harmful than smoking and absolutely have a strong role to play as a cessation aid for adult smokers seeking to quit. In fact, clients of stop smoking services who have used a vape to quit have had the highest success rate of any group. Nevertheless, a concerning increase in youth uptake should not be ignored. In 2023, one in four children aged 11 to 15 tried vaping, often drawn in through appealing sweet-like flavours and colourful packaging.
In response to this challenge, the Bill includes measures which address the rise in youth vaping and other nicotine products. We will ban advertising and sponsorship, and implement regulations concerning the flavours, descriptions, ingredients, packaging and point-of-sale displays of these products. The intention here is clear. We will ensure that the marketing of vapes can no longer target minors. However, it is imperative that the Bill strikes a necessary balance, ensuring that vapes remain an accessible option for adult smokers looking to transition away from dependence on tobacco, while clamping down on youth vaping.
The public understand the importance of this Bill and what it aims to achieve. Some 69% support a smoke-free generation policy, while 82% of adults support banning names of sweets, cartoons and bright colours on vape packaging, and 81% support banning the advertising and promotion of vapes at the point of sale.
This Bill is the product of the combined effort of Members of both Houses and many outside Parliament over the course of many years. A key manifesto commitment of this Government is to create a smoke-free generation, and this Bill has rightly received support from across the political parties. I express my thanks to many—over, as I said, many years—but I particularly thank the former Prime Minister, the right honourable Rishi Sunak MP, who committed to the original form of this Bill. I also thank my ministerial colleague, Ashley Dalton MP, and the members of the All-Party Parliamentary Group on Smoking and Health. Many others have also informed and motivated the action by this Government.
As we turn our attention to the substance of the Bill, I want to highlight its core aims. At its heart, the Bill is about safeguarding the health of our population. Its fundamental principle is to address the cycle of addiction and societal disadvantage. It is a key component of our broader health mission: a commitment to shift from treatment to prevention. Under our Plan for Change, the Government are committed to ensuring a sustainable health system that moves healthcare from hospital to the community, from analogue to digital and from sickness to prevention.
The Bill incorporates a UK-wide approach, reflecting the need for change across our four nations. Health is a devolved matter, so the Bill has been developed in close partnership and collaboration with the Scottish Government, the Welsh Government and the Northern Ireland Executive. This ensures not only greater consistency across the nations but a more enforceable regime across the UK.
In addition to creating a smoke-free generation, the Bill will amend the existing powers to designate certain outdoor settings as smoke free. This will offer greater protections to those at risk from the harms of second-hand smoke. Any such extension will be carefully considered and subject to consultation. In England, the Government will consult on banning smoking outside locations frequented by children and vulnerable people, such as schools, hospitals and playgrounds, but not outdoor hospitality or wider open spaces. Private outdoor spaces are out of scope of the powers in the Bill.
In addition, the Bill provides regulation-making powers to address the entire life cycle of tobacco, vaping and nicotine products, enabling the Government to set appropriate product standards to protect consumers. The introduction of a pre-market registration scheme will provide comprehensive oversight of manufacturers and the products they introduce to our stores. Retail licensing provisions then facilitate ongoing monitoring and modification of retailer practices, strengthening enforcement and ensuring adherence to the measures we put in place.
It is important to acknowledge, as I know many noble Lords do, the dynamic nature of the products we are discussing and the fact that our scientific understanding of their long-term impact continues to evolve. Therefore, the Bill allows for the highly technical details of the regulatory regime to be set out in subsequent regulations that are well placed to adapt to emerging evidence and market innovations.
This is not just about the Bill. The Bill is part of a wider effort across government to address the challenges of smoking and youth vaping. The Government are actively supporting current smokers who wish to quit. We are increasing funding for local stop smoking services by an additional £70 million in 2025-26 and delivering national action, such as the national smoke-free pregnancy incentives scheme and the vaping Swap to Stop scheme.
The Department for Environment, Food and Rural Affairs has laid legislation that will see the ban of single-use vapes from 1 June this year, addressing a key factor in youth vaping as well as environmental concerns. Moreover, to discourage non-smokers and young people from starting vaping, and to generate revenue for public services, the Government will introduce a vaping products duty, which will come into force from 1 October 2026. In order to continue to incentivise smokers to quit and keep the differential in price, duty rates on all tobacco products were increased by 2% above inflation in the Autumn Budget, with further additional increases for hand-rolling tobacco to reduce the gap with cigarettes.
We recognise the importance of robust enforcement of our new laws and regulations, so the Government have announced £10 million of new funding in 2025-26 for Trading Standards to tackle the illicit and underage sale of tobacco and vapes, and to support implementation of the measures in the Bill. In total, we will invest £30 million of new funding in 2025-26 for enforcement agencies, including Trading Standards, Border Force and HMRC.
I extend my gratitude to noble Lords on all sides of the House for their ongoing support for the Bill and for getting it to this stage. The time to act is now, which is why this is priority legislation for this Government and why we have gone further than the previous Government. I look forward to the collegiate and constructive debate that I know will follow from my engagement thus far, and I will seek to respond to the main questions and themes. I beg to move.
Baroness Merron (Lab)
My Lords, I am grateful to all Members of your Lordships’ House who have contributed to what has been a thoughtful and wide-ranging debate on a very important issue.
Today’s debate has been very well supported. I hope that noble Lords will understand that I will not be able to cover in my summary every issue that has been raised, but I will endeavour to respond to as many of the themes and questions as possible. Of course, I will be happy to have further discussions with noble Lords, and we will have the opportunity for these ahead of and during future stages of the Bill. I too look forward to Committee.
It seems many hours ago since my noble friend Lady Thornton spoke of the measures in this Bill being a further step along the way. I share that view, which has been expressed by a number of other noble Lords, particularly those in what I shall politely call the cohort of former Health Ministers. I do not know what the collective term is, but I am sure we will work on that. I am in that cohort, and I too worked towards the initial smoking ban in 2007. As a Public Health Minister, I introduced the display regulations we are now so used to. When we introduced the original ban in 2007, no one could have dreamed of the challenges we have today, including vaping; this was not something we had considered. It was also important to go with the public, which is why I was keen to outline the public’s support in my opening remarks.
I am grateful for the challenge. I have heard many concerns being expressed today, along with outright opposition to the Bill. I have also heard much support for the Bill, although there are rightly questions about the measures in it. Many noble Lords have been supportive, including the noble Lords, Lord Lansley and Lord Stevens, who assisted me by anticipating some of the arguments that will be deployed. The noble Baronesses, Lady Redfern and Lady Smith, and many others, were also very supportive.
I am grateful to my colleagues on both Front Benches for taking a line similar to the one I am about to take in respect of the Chief Medical Officer’s views. These include:
“If you smoke, vaping is safer; if you don’t smoke, don’t vape.”
I am also very grateful to noble Lords who were good enough to join me yesterday at a briefing with the Chief Medical Officer and officials, which I certainly found helpful. I know that others did too.
I understand that there are different perspectives on a number of issues, and I now turn to some of the points that were raised. I heard concerns about the smoke-free generation policy from a number of noble Lords, including the noble Lords, Lord Scriven, Lord Brady, Lord Naseby, Lord Sharpe, Lord Teverson and Lord Moylan. However, the reality is that smoking leads to significant harm. A clear majority of smokers regret ever having started. My noble friend Lord Browne spoke about this, as did the noble Lord, Lord Vaizey, who recounted his own personal experience. Many people struggle to give up due to the addictive nature of nicotine.
I am grateful to a number of noble Lords for sharing their personal experiences, which brought colour and a human touch to our debate. These included the noble Lords, Lord Jopling and Lord Rennard, my noble friends Lady Rafferty, Lady Ramsey and Lord Griffiths, and the noble Baroness, Lady Morgan.
However, let us remember that the harms of smoking extend beyond the individual. They impact on non-smokers, especially children and pregnant women, through second-hand smoke. This policy will be the most significant public health measure in a generation. It will build on the previous steps I spoke of, such as the 2007 indoor smoking ban, with the goal of safe- guarding the health of future generations from preventable and serious harm. That is why we are bringing the Bill forward.
The noble Baroness, Lady Fox, decried the Bill on a number of levels, including—she must forgive me if I am wrong on this—that it is Tory legislation. Actually, this is a Bill on which we are agreed across the House and across parties. Of course there are questions, but a wise Government and wise Opposition Benches acknowledge good when they see it. That is where we are today.
A number of noble Lords suggested raising the age of sale to a particular age—for example, 21 or 25—as a potential way to address smoking. As the noble Lord, Lord Bourne, put so well, that would not stop young people starting to smoke. The whole point is that, once you have started to smoke, the challenge of giving up is tremendous, because it is an addiction. Introducing a particular age could have a positive impact but it will not fully achieve the ambition of a smoke-free UK. Our goal is to go further, to break the cycle of addiction. We want to drive smoking rates down to 0%. That is why we have suggested a smoke-free generation.
On the practicalities, implementation is absolutely key. On ID checks, the majority of retailers sell tobacco and vapes responsibly—I acknowledge that. They follow the recommended practice and regularly ask for ID from customers. The Bill provides powers to specify in regulations the steps that may be taken to verify a customer’s age, to provide clarity and to support retailers. The noble Baroness, Lady Walmsley, spoke to this point. We are exploring how we can enhance age verification with digital verification services, providing an opportunity to securely verify age, both in person and online.
With regard to the products in scope, the Bill captures all tobacco products, as tobacco is uniquely harmful. There are around five times more people smoking non-cigarette tobacco, such as cigars, than a decade ago, and the greatest increase is among young adults. To the noble Earl, Lord Howe, and the noble Lord, Lord Vaizey, I would say that this is why the Bill, importantly, captures all tobacco products and must not be watered down to exclude certain products.
The noble Earl, Lord Lindsay, and the noble Lords, Lord Strathcarron, Lord Scriven and Lord Brady, referred to other products outside of this range. I again call upon the words of the Chief Medical Officer: there is no safe level of tobacco consumption. That is what sets it apart from other products that we might feel are harmful. There is no safe level, not even a little bit; that is the key. Therefore, cigars, shisha and heated tobacco are all in scope. To the point raised earlier about heated tobacco, there is evidence from laboratory studies of its toxicity, and there are, as noble Lords have spoken of, less harmful tobacco-free products to support people to quit, rather than heated tobacco.
A number of noble Lords raised points about the growth in illicit sales. The noble Lords, Lord Dodds, Lord Blencathra, Lord Naseby, Lord Scriven, Lord Howard and Lord Murray, the noble Baroness, Lady Hoey, and the noble Earl, Lord Leicester, were concerned that the Bill’s ambitions could be undermined in this respect. As other noble Lords have said, history shows that when we have introduced targeted tobacco control measures, the size of the illicit market has not increased. As the noble Lord, Lord Bichard, told the House, it has in fact continued to fall. When the age of sale increased from 16 to 18, the number of illicit cigarettes consumed fell by 25%.
On the point raised by the noble Baroness, Lady Walmsley, the Government are cracking down on the demand for illicit trade, as well as the supply, with the joint strategy with HMRC and Border Force backed up by over £100 million of new funding over five years.
I am grateful to the noble Lord, Lord Bichard, for articulating support for those who work in trading standards as well as acknowledging their worth, and I share his views on that. As these were points raised by the noble Lords, Lord Moylan and Lord Udny-Lister, it might be helpful to reiterate that we have announced £10 million of new funding in 2025-26 for trading standards to boost the workforce and tackle the illicit and underage sale of tobacco and vapes.
A number of questions were raised about whether driving down the smoking of tobacco could lead to an increase in the smoking of cannabis. As the noble Lord, Lord Kamall, accurately said, the Bill is not banning the smoking of anything—it is in reference only to tobacco and vapes. I also ought to say that we are not aware of any link between the rates of smoking cannabis and the rates of smoking tobacco. I know that noble Lords are more than aware that cannabis is, of course, illegal.
On the matter of abuse against retail staff, raised by my noble friend Lady Carberry, we are working closely with retailers and will utilise the long lead-in time to best support them in preparing for and implementing these changes. That includes rolling out information campaigns for both the public and retail workers. We will not stand for violence and abuse against shop workers; everyone has the right to feel safe. To protect hard-working and dedicated staff who work in stores, this Government will introduce a new offence of assaulting a retail worker.
On the issue of smoke-free places, in England we intend to consult on extending smoke-free outdoor places to outside schools, children’s playgrounds and hospitals, but not—I say to my noble friend Lord Faulkner —to outdoor hospitality settings or wider open spaces such as beaches. This is because—and it might be helpful to the noble Baroness, Lady Bray, as an assurance—we judge that this adequately balances a range of priorities by protecting the most vulnerable while ensuring that businesses are not financially impacted.
There was a lot of discussion about the rationale for the broad powers, including within the Bill. Noble Lords are right to point to the high number of regulation-making powers that the Bill takes. I have no doubt that noble Lords have enjoyed or will enjoy scrutinising the 96-page delegated powers memorandum, which sets out in full the detail of the rationale for each and every one of the powers. I recommend it as good reading. Concerns were particularly raised by the noble Earl, Lord Howe, the noble Lord, Lord Blencathra, and the noble Baronesses, Lady Hoey and Lady Meyer. I assure noble Lords that each of these powers has been carefully considered and aims to ensure that the Bill establishes a clear regulatory regime for tobacco, vaping and nicotine products, and that we have worked very closely with the Attorney-General’s Office to get it in the right place.
As the noble Baroness, Lady Northover, spoke to, given the need to adapt to emerging scientific understanding and to market innovations, it is crucial that the details of the regime are set out in regulations, to ensure sufficient flexibility. In addition, most of the regulations require significant technical detail, which is more appropriate for secondary legislation.
As some noble Lords referred to, the Bill is UK-wide, so certain powers are being repeated for each part of the UK. Equally, the Bill restates or amends a number of existing powers from across tobacco control legislation, to bring it together in one place. That will help to make legislation more useful and accessible.
I can assure noble Lords that the Bill provides a statutory requirement to consult on regulations, and we are working constructively with retail associations and the Local Government Association to help shape the early design of the scheme. The noble Lord, Lord Mott, was right to say that we should support responsible retailers, who are the majority and who want to do the right thing. They do not want to be undermined by those who are not being responsible. I put that to the noble Lord, Lord Udny-Lister, who was concerned about impact.
On the matter of balance in respect of vapes, there was a useful debate, both in the Chamber and at a meeting I held with the Opposition Front Bench, about the matter of flavours. To avoid unintended consequences on adult smoking rates, the scope of restrictions will be carefully considered and consulted on. The noble Earl, Lord Howe, raised the issue of exemptions from the advertising ban for public health purposes. We are clear that healthcare providers can continue to provide advice about vaping as a smoking cessation tool. For example, pharmacists could display public health campaign messaging or provide advice to customers about vaping as a smoking cessation tool. I wish to say to my noble friends Lady Mattinson and Lord Hanworth, as well as the noble Earl, Lord Russell, that we will keep emerging evidence under review, and have already commissioned a 10-year study to investigate the long-term effects of vaping on the health of 100,000 young people, which I hope will be helpful.
On the matter of filters and the environment, I understand and am sympathetic to the concerns raised by noble Lords, including the noble Baronesses, Lady Grey-Thompson and Lady Bennett. The environmental harm of items with tobacco butts is evident, as it is the most littered item in the UK. Ultimately, the best way to tackle this littering is through reducing smoking rates, but we are where we are. Local authorities already have powers to tackle littering, including through the ability to issue fixed penalty notices of up to £500. We are working closely with Defra to take a systematic approach to what is indeed something of a blight.
On the matter of age and the concerns, including twins born either side of midnight, should such a thing ever happen, I remind noble Lords that other policies already do this, such as universal credit increases, NHS screening programmes and access to vaccines.
On the “polluter pays” levy, raised by the noble Lords, Lord Crisp and Lord Young of Cookham, my noble friend Lord Faulkner and the noble Baroness, Lady Walmsley, the Government’s present preference is, as I think noble Lords are aware, to continue with a proven and effective method of dealing with tobacco products through increases in tobacco duties, to incentivise those who currently smoke to quit, and to generate finances that can be put back into public services.
I am most grateful to the noble Lord, Lord Bethell, for his support for the Bill and appreciate the intentions behind his suggestion to be smoke-free by 2040.
On the points about the Windsor Framework, I have heard the concerns about the application of smoke-free generation policy in Northern Ireland from the noble Lords, Lord Dodds and Lord Weir, the noble Baroness, Lady Hoey, and my noble friend Lady Ritchie. I have met the Northern Ireland Health Minister, and we continue to work well with his office. I assure noble Lords that we are content that the measures intended to apply to Northern Ireland are consistent with the obligations in the Windsor Framework.
In closing, I am most grateful to all noble Lords who have contributed to this debate. This is a landmark Bill, and it will be the most significant public health intervention in a generation, so I beg to move.
Funerals: Death Certificate Delays
Baroness Merron Excerpts(3 weeks ago)
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Viscount Stansgate
To ask His Majesty’s Government what steps they are taking to reduce reported delays in holding funerals because of changes in the provision of death certificates.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, the death certification reforms are increasing scrutiny of deaths and patient safety, and supporting the bereaved. We are taking steps to reduce the time to register a death, through active monitoring of the reforms, using weekly data from the ONS to target the challenges and the necessary support. We are also working with faith groups and the funeral sector to identify and reduce any obstacles, and sharing any concerns we receive with NHS England so that they can be swiftly resolved.
Viscount Stansgate (Lab)
I thank my noble friend for that Answer. When my dad died—incidentally, he was born 100 years ago today—it was possible to arrange his funeral in two weeks. That is not now possible. I have talked to the National Association of Funeral Directors, and I understand that there is a lot of confusion around the country about the new procedures, although everyone understands why they are there. Is there more that could be done in hospitals or by GPs to help families who are having to cope with the unfamiliarity of the new procedures at the time of their own grief? More widely, might it be possible for the Government to start considering regulating the funeral profession, as has happened in Scotland?
Baroness Merron (Lab)
I am sure that we all wish to pay tribute to the memory of my noble friend’s late father. I appreciate the points that he has made. It is not the case that delays to funerals can be identified and formally linked with the changes in death certification. My noble friend raised a lot of points, many of which are valid. In a bereavement, it is more important than ever that any official processes—as well as the funeral sector itself—work as seamlessly and sensitively as possible. I assure my noble friend that not only are we driving improvement by implementing the death registration reforms but we are very focused on supporting the bereaved. On my noble friend’s point about regulation, I am not aware of any plans at present.
Lord Scriven (LD)
My Lords, to solve a problem, first you have to accept that it exists. Everyone involved in funerals, from the GPs doing the certification to the funeral directors, say that there is a direct link between the extra time to deal with funerals and the reforms. The reforms were needed, but can the Minister clarify the number of medical examiners required in each region—because regional variation exists—to prevent lengthy delays in funeral arrangements? What assessment have the Government made to ensure that the current number of medical examiners is sufficient to meet regional demand?
Baroness Merron (Lab)
I do not have the figures to hand, but I would be very pleased to write to the noble Lord. As I said, this is a complex area. The reforms were introduced in September, and it is very difficult to make before and after comparisons. Since 2001, a long-term trend has shown an increase in the median time between death and registration, and that cannot be attributed to death certification reforms. In addition, the reforms are about the introduction of statutory medical examiners as opposed to the non-statutory arrangements that existed before—and there was even more regional variation before September than we are finding now. I assure your Lordships’ House that I am working very closely with officials to understand the reasons for this so that we can take more action.
Lord Kamall (Con)
My Lords, I thank the noble Viscount, Lord Stansgate, for the conversation we had about this Question. As we all know, when a loved one passes away, it is a distressing time, and surely delays can only add to that distress. I am sure that noble Lords understand why these reforms were brought about in the first place: they were introduced after a qualified doctor, Harold Shipman, murdered his patients and signed the death certificates himself. In a recent Written Answer on these delays, the Minister for Public Health in the other place said:
“The expectation on doctors and medical examiners is clear … they should complete certification as quickly and efficiently as possible, and the Government is working with all stakeholders to make sure this is the case”.
Can the Minister explain to your Lordships what that means? Is the department simply asking them to complete the certificates, or is it identifying blockages or misunderstandings in the system to help unblock them in order to speed up the process?
Baroness Merron (Lab)
The noble Lord’s observations are correct. As I said, it is so important to be timely and sensitive at a time of bereavement. Governments and Ministers have been working to bring in the system over the last 50 years—in fact, it has been overdue for reform for that long, so I am very glad to have taken this action. Introducing this robust system means working with medical examiners as well as the bereaved, so that we hear from them about what has happened. We also work very closely across government, including with the MoJ and the Home Office. As the noble Lord will know, the medical examiner system is led by NHS England through the office of the National Medical Examiner. I reiterate that delays are not due solely to this introduction; it is very important to unpick this issue. We now have better data and get weekly reports, which is helping greatly.
Baroness Finlay of Llandaff (CB)
My Lords, at the Commission on Palliative and End-of-Life Care, chaired by Professor Sir Mike Richards, we have heard from medical examiners and the bereaved. It is clear that the ability for the bereaved to speak to a medical examiner and go through things in detail is very supportive. However, the delays in notifying the cause of death and transferring the case notes seem to be from the doctor who had seen the patient. The medical examiner cannot start until both those events have happened, and at that point their work begins. So the increasing digitalisation of the health service and of notifications could speed up these processes. Does the Minister agree that the digitalisation proposals from the noble Lord, Lord Darzi, will bring about those changes and simplify the process?
Baroness Merron (Lab)
I agree that those changes—the move from analogue to digital, which will be outlined in the 10-year plan—will indeed help in this area, as well as many others.
Baroness McIntosh of Hudnall (Lab)
My Lords, clearly, this is a complex and difficult issue, and there does not seem to be any one reason why these delays have started to extend. Can the Minister tell the House whether there are any financial implications for people who have to wait much longer for a funeral to be arranged, given that they are not cheap to begin with?
Baroness Merron (Lab)
I am not aware of the specifics around that point, but we will be very pleased to look into that because we do not want people to be inconvenienced and distressed even further.
Lord Polak (Con)
My Lords, the Minister will know that, in the Jewish community, we bury our deceased within 24 hours. I have not noticed any change in that since September—so perhaps that fact will help her.
Baroness Merron (Lab)
I am grateful to the noble Lord. He is of course aware that, as the former chief executive of the Board of Deputies of British Jews before coming to this place, I worked on this very area to ensure that there were swift responses and burials for the faith communities that require them. That continues to be a great focus of our work.
Lord McCrea of Magherafelt and Cookstown (DUP)
My Lords, in Northern Ireland, the practice is that funerals are held three days after death. Does the Minister think that anything can be learned from that?
Baroness Merron (Lab)
We are always happy to learn from the practices of other Governments, and we will continue to work on speed and, as I said, to keep distress and delay at a minimum.
Lord Rook (Lab)
My Lords, I point to my entry in the register of interests as an Anglican priest. I am particularly glad that my noble friend the Minister mentioned the challenges for faith communities and the important role that ministers of religion have not only in conducting funerals but in supporting families with grief and loss. Obviously, a delay to those things can cause family stress and tension. What are the Government doing to engage Muslim communities, which particularly feel the stress and pressure of this issue given their obligation to have swift funerals?
Baroness Merron (Lab)
I pay great attention to this area, as I mentioned in my response to the noble Lord, Lord Polak. I met faith group leaders in December, and we have worked very closely with faith groups to develop the medical examiner system. The faith groups are very supportive of the reforms, have broadly welcomed the implementation and continue to work with us to identify any issues, for which I am very grateful. Data from regional medical examiner offices in England, although unpublished, indicate that 88% of requests for urgent scrutiny—the group we are talking about in the faith communities—were met. Indeed, in Wales the corresponding figure has been assessed to be 99%. I assure all noble Lords that we are working extremely hard to make sure that the system reduces any unnecessary delays, and we will continue to do so.
NHS Pensions
Baroness Merron Excerpts(3 weeks ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
It may be helpful if I respond to the noble Lord by saying that a compensation scheme is already in place to cover direct financial losses, certain HMRC interest charges and the costs of financial and accountancy advice. On the specific point that the noble Lord raises, I will be very pleased to answer further on the response of my honourable friend in the other place.
It is also important to remember that this arises from a reform to public service pension schemes in 2014 and 2015 under the coalition Government. As part of those reforms, older pension scheme members were given protections enabling them to stay in legacy schemes, but younger members were moved on to reformed schemes. Therefore, legal cases were brought, and the Court of Appeal found against the then Government. We are dealing with an inherited situation, and we are working at pace to get the right things to people, but also in order that people do not lose out.
Lord Scriven (LD)
First, I have to declare an interest as a member of the NHS pension scheme. To be helpful, will the Government look at taking two urgent measures to help alleviate some of the problems that the late delivery of these statements has caused? The first is to extend the carry-forward rules from three to five years, and the second is to provide an immediate remedial service statement for those needing transitional tax-free amount certificates. If the noble Baroness cannot answer in full, a written response would be welcome.
Baroness Merron (Lab)
I am very glad that the noble Lord has given me that option, which I will gladly take. Perhaps it would be helpful to your Lordships’ House for me to say that the deadline to issue remedial service statements was 1 April or later. That was not achievable because of the level of technical complexity, capacity, and delays in HMT and HMRC setting out lower-level policy requirements under the previous Government, so Minister Karin Smyth extended this deadline last week and published a new timetable. Separately, 137,000 higher-earning members of the NHS pension scheme require remedial pension savings statements as part of their remedy. The deadline for that was 6 October. HMRC did not allow this to be amended. The current position is that, to date, 94,012 statements of the 137,000 have been issued. These delays are due fundamentally to the annual allowance element of the remedy being poorly designed and, again, late requirements provided by HMT and HMRC. To say that this is a knotty problem would be underestimating it.
Baroness Watkins of Tavistock (CB)
I thank the Minister for the assurance in the Statement that no individual member will in the long term suffer financial detriment. However, is she able to explain how the NHS Business Services Authority issued 23,000 inaccurate statements against 57,000, which is over 30%, and what are we doing to get efficiency and effectiveness from this authority?
Baroness Merron (Lab)
I appreciate the point that the noble Baroness refers to. The priority is to get this matter resolved, as she will appreciate. With respect to the NHSBSA, we will also be working closely with it to ensure that the correct service is given in future. Obviously, I want to see this put right to assure people as soon as possible.
Lord Davies of Brixton (Lab)
I thank my noble friend for her further clarification of the issues here. This is an extremely complex issue, and I know that better than most because I was involved in the original negotiations, going back to 2011.
What was disappointing about the discussion in the House of Commons on this issue was that there was overemphasis on working out who was to blame rather than on achieving a solution at pace. I thank the Minister here for focusing. Can she give an assurance, first, that everything is being done to resolve this situation? There is also the issue of the way in which the Statement is worded, referring specifically to financial loss. Those people have had to suffer high levels of uncertainty and delay in making their arrangements, which is not easily captured in the term “direct financial losses”. They will be significantly concerned about that lack.
Finally—I feel some sympathy for my noble friend—this is an issue that runs across all the public service schemes. Similar problems are arising in other schemes, not quite to the same extent, but there is failure there. Does my noble friend agree that this illustrates that any changes to public service pensions need to be considered extremely carefully, before we end up with similar problems down the line?
Baroness Merron (Lab)
I certainly agree with my noble friend. This runs across all public service pensions. Indeed, it is not just the issue of pensions but the administration and support given. To the point raised by both my noble friend and the noble Baroness, Lady Watkins, I should add that the NHS Business Services Authority and the department are in regular contact with the Pensions Regulator on delivery.
I can certainly give the assurance to my noble friend that we are working cross-government to ensure that these difficulties are corrected as soon as possible. I absolutely recognise the inconvenience, uncertainty and potential distress that have been caused to individuals. As I say, this has a root in it being discriminatory from 2014-15. That said, it falls to us to put that right.
Baroness Altmann (Non-Afl)
My Lords, does the noble Baroness agree that at the heart of this problem is the complexity of our pension system and the tax rules, which have undermined the generosity of public sector pensions, which are meant to be a really generous benefit but have turned into a hugely unwelcome cost for our most senior medical staff and nursing staff, as well as others in the public sector? Is she looking, at the same time as trying to correct some of these errors, at finding other ways of improving the problems in the scheme, which will remain even after the statements are issued, such as doctors and nurses themselves having to go on to an HMRC tool to retrospectively adjust their annual allowances for the various tax years going back all those years? Will there be consideration of addressing the cost of scheme pays? Has consideration been given to providing independent financial advice for senior members of the scheme, who would then have some comfort that what they are frightened of—and is driving early retirement or stopping overtime—is either unnecessary to worry about or can be dealt with in another way?
Baroness Merron (Lab)
I very much value the noble Baroness’s expertise in this area, so I particularly value her acknowledgement of the complexity of the scheme. Certainly, in our efforts to support the workforce, we consider all matters to make working for the NHS better and simpler. There has been talk—the noble Baroness did not quite say this—that pension issues are impacting NHS activity. There is no evidence of that. Nor is there any clear evidence from NHS payroll data that pension tax rules limit the activity of, for example, the consultant workforce overall. All that said, I, as ever, will be pleased to take away the suggestions that the noble Baroness makes and to have them looked into.
Mental Health Bill [HL]
Baroness Merron ExcerptsWednesday 2nd April 2025
(3 weeks, 1 day ago)
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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.
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.
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.
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.
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.
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.
Baroness Merron
“(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.
Baroness Merron
“(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 ExcerptsMonday 31st March 2025
(3 weeks, 3 days ago)
Lords ChamberRead Full debate Mental Health Bill [HL] 2024-26 View all Mental Health Bill [HL] 2024-26 Debates Read Hansard Text Watch Debate Read Debate Ministerial Extracts Amendment Paper: HL Bill 73-I(a) Amendment for Report (Supplementary to the Marshalled List) - (28 Mar 2025)
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.
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.
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.
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.
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.
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.
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 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.
Baroness Merron
(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.
Baroness Merron
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.
Baroness Merron
“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.
Baroness Merron
Member’s explanatory statement
This is consequential on my amendment to leave out clause 50.
Mental Health Bill [HL]
Baroness Merron ExcerptsMonday 31st March 2025
(3 weeks, 3 days ago)
Lords ChamberRead Full debate Mental Health Bill [HL] 2024-26 View all Mental Health Bill [HL] 2024-26 Debates Read Hansard Text Watch Debate Read Debate Ministerial Extracts Amendment Paper: HL Bill 73-I(a) Amendment for Report (Supplementary to the Marshalled List) - (28 Mar 2025)
Baroness Merron
“(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.
Baroness Merron
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).
Baroness Merron
“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?
Baroness Merron (Lab)
I will answer the question at the end for simplicity; I do have an answer for the noble Baroness.
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.
Food, Diet and Obesity Committee Report
Baroness Merron Excerpts(3 weeks, 6 days ago)
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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(1 month ago)
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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.