Mental Health Bill [HL]

Baroness Merron Excerpts

Tuesday 14th January 2025 Lords Chamber

[The Earl of Effingham (Con)]

My Lords, I thank the noble Baroness, Lady Tyler, my noble friend Lady Browning, the noble Lord, Lord Scriven, and the noble Baroness, Lady Hollins—who sadly is not in her place today—for their amendments in this group.

Given that it is now widely accepted that we should be moving towards a system of health and care focused on prevention, these all appear to be sensible amendments. They seek to understand how integrated care boards and local authorities are identifying those with autism or learning disabilities, the risk of them being detained and, if appropriate, the risk to the community, as well as ensuring that those with autism and learning disabilities receive the appropriate level of care.

Amendment 28, in the name of my noble friend Lady Browning, specifies that local authorities must seek to ensure the needs of people with autism and learning disabilities can be met without detention when they are exercising not only their market function but their commissioning functions. This acknowledges the roles that local authorities play in commissioning health and social care. Local authorities commission publicly funded social and healthcare services, many of which interact with mental health service provision, such as authorised mental health professionals and addiction services. By explicitly mentioning the commissioning functions of local authorities and not just the market functions which arise out of the Care Act 2014, this amendment gives the Bill greater clarity.

The noble Baroness, Lady Hollins, has tabled Amendments 36 and 37 in this group, which relate to the provision of community services for autistic people. These amendments are in a similar vein to Amendment 139 in the name of my noble friend Lord Kamall, which will be discussed in the next group and which seeks to ensure a greater availability of community services. Amendments 36 and 37 expand the duties on integrated care boards and local authorities to provide better and more responsive care to those on dynamic support registers.

Of particular interest is subsection (3)(a) of the new Section 125I proposed in Amendment 37. That new provision states that integrated care boards must

“establish digital systems to … assess, monitor, and address sources of inequality”

arising out of the current provision of mental health care. As my noble friend Lord Kamall has been keen to stress, digitalisation in health and social care is the way forward for improving productivity and ensuring the best possible care outcomes.

I know the Minister believes in the value of the expanded use of technology and digital systems, and it would be welcome if she could give some commitment here. When we hear from her, we would be interested in whether there are any legal reasons for not being able to accept what these amendments seek to do, such as around issues of privacy, or whether the barriers are financial. We very much look forward to the response of the Minister.

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

My Lords, I am most grateful to the noble Lords present for their contributions this evening. Perhaps I can make a general point to the noble Baroness, Lady Tyler, and the noble Earl, Lord Effingham, about the main pillars of change which we look forward to in the 10 year-plan. The noble Earl has just referred to one of them, which is the move from analogue to digital. In that context—the noble Baroness raised a point about parity between mental health and physical health—the moves from sickness to prevention, from hospital to community and from analogue to digital apply at least as much to mental health as they do to physical health. That is our way forward. I am looking forward to the 10 year-plan to really give structure to that.

Let me turn to Amendment 21, tabled by the noble Baroness, Lady Tyler. This amendment seeks to ensure that the register under new Section 125D includes autistic children and children with a learning disability who have risk factors for detention, so that they can be supported in the community. We absolutely agree with the intention behind the amendment, although I have to say that it is regarded as unnecessary because the current drafting does not limit the duty to adults; it includes anyone who meets the other criteria, including children, which I know the noble Baroness is rightly looking for. The register is designed to provide health and care bodies with additional information about the needs of those with a learning disability and autistic people who have risk factors for detention under Part II of the Act. That is to ensure there is a particular focus on their needs, so that they can be better supported in the community.

The noble Baroness, Lady Tyler, made the observation, which I understand, about too many children being left to reach crisis point and the increase in the number of children in need of mental health services, particularly over the last three years. I very much recognise this concern. We have seen an increase in referrals and access across children’s and young people’s mental health services, including crisis services. This is due to an expansion of the services to meet need but also to an increase in prevalence and intensity. It might be helpful if I indicate that NHS England is in the process of developing proposals for a new model of specialised children’s and young persons’ mental health services, supported by a new service specification and quality standards. This new approach would support delivery of specialised services in the community, as well as in appropriate in-patient settings close to the child’s or young person’s family and home. That is a matter that has been raised many times in this Chamber and one that I am very sympathetic to.

Amendment 22 was tabled by the noble Lord, Lord Scriven, and supported by the noble Baroness, Lady Browning. If taken forward, this amendment would require each local authority to assist the integrated care board in its duties in respect of support registers for people with a learning disability and autistic people. We certainly agree with the intent of this, and I am pleased to be able to provide reassurance that the clause already provides the Secretary of State with the general power to make further provision about the register in regulations. We expect this to include detail on how relevant information is to be obtained and from whom. This is to include the role of local authorities, alongside other relevant health and care bodies, in providing further relevant information.

We believe that it is most appropriate to include this detail in regulations rather than in primary legislation, since the way in which information is obtained, what information is obtained and who might be involved may change with emerging best practice. As noble Lords will realise, that point has been made in respect of a number of these amendments. Returning this to Parliament at every instance would be disproportionate.

However, it is important that the process actively involves health and care system partners. We are clear that the integrated care board must retain overall responsibility for the register. Providing a list of named bodies that have a role in providing information in the legislation may create an unintended diffusion of responsibility, which could negate the benefits of putting these registers on a statutory footing.

[Lord Scriven (LD)]

I am sorry to interrupt the Minister in mid-flow. She has just explained why it would be wrong to put the process for collecting the data in the Bill, with which I completely agree, but my amendment does not seek to do that. It seeks to make it a legislative requirement of local authorities to be part of the process.

The reason I have tabled the amendment—and I am sure it is the same for the noble Baroness, Lady Browning, in putting her name to it—is that NHS England’s figures say that a lot of people who are admitted to hospital, 52%, are not on the register, but many will have come into contact with the local authority. That is why it is important for the Bill to make local authorities part of the process of identifying who should be on the register. That would subsequently allow the Government to provide statutory guidance about the collection of the data, but it is important that there is a statutory duty in the Bill to do that.

[Baroness Merron (Lab)]

I thank the noble Lord for adding to the points that he made in response to my comments and the assurances that I have just given, and I am happy to review them. I understand the intent.

Amendments 24 and 29, tabled also by the noble Lord, Lord Scriven, seek to impose a duty on integrated care boards and local authorities to consider information in the register, or obtained by virtue of this clause, when exercising certain existing functions. I strongly agree with the principles behind these amendments, although it is considered that the current drafting in the clause, which requires both integrated care boards and local authorities to “have regard to” the relevant information, already achieves the intended effect. The common duty to have regard is one that both integrated care boards and local authorities are familiar with and used to applying. In this context, we expect this duty to result in careful consideration being given to the information.

Departing from the wording of a well-established duty could create ambiguity, leaving it to the interpretation of individual integrated care boards and local authorities. As I can see the noble Lord agrees, that would be a very undesirable outcome. It may inadvertently create a weaker duty than that set out in the Bill or lead to variation in interpretation and response to the duties.

If Amendments 25, 26, 30 and 31, tabled by the noble Lord, Lord Scriven, were taken forward, they would put a duty on integrated care boards and local authorities to ensure that the needs of people with a learning disability and those who are autistic could be met without detaining them, unless there was a compelling reason why that was not possible. A point was raised, including by the noble Lord, Lord Crisp, about difficulties in enrolment on dynamic support registers and the need to address that in the Bill. DSRs are part of existing NHS England policy and we have heard that they can be effective in preventing hospital admissions. That is why we propose putting these important registers on a statutory footing and making them a requirement.

The Bill already places duties on integrated care boards and local authorities to seek to ensure that the needs of those with a learning disability and of autistic people can be met without detaining them under Part II. This is a legal requirement to ensure that particular attention is paid to the needs of people with a learning disability and of autistic people, and that services should be commissioned accordingly.

Mental Health Bill [HL]

Baroness Merron Excerpts

Tuesday 14th January 2025 Lords Chamber

[Lord Kamall (Con)]

I begin by thanking all noble Lords who spoke to this first group of amendments in Committee. Before I comment, I refer noble Lords to my interests as set out in the register. I am not an honorary fellow of the Royal College of Psychiatrists, noble Lords will be relieved to know, but I should mention my previous work with a couple of think tanks—the Institute of Economic Affairs and Politeia, which have both published on health and social care issues. There is also my work at St Mary’s University, where I am a professor of politics and international relations, and which has recently applied to open a new medical school. I also sit unpaid on the advisory board of a start-up coalition, and I know that there are a number of start-up companies helping people with mental health conditions. I just wanted to cover those interests, in case anyone made any accusations.

This group addresses the principles that will guide the application of the Mental Health Act, as set out in the Wessely review. Sir Simon pointed out, rightly, that there are already guiding principles in the code of practice, but that

“there is limited awareness of these, and it seems very likely that they do not inform practice in the way they should”.

Clearly, as noble Lords said at Second Reading, the important aim of including the four principles is to improve their application and ensure the highest level of care and therapeutic benefit for patients, while ensuring that all patients are treated as individuals.

I thank the noble Baroness, Lady Tyler, for her Amendment 1. Of course, equity is at the heart of the Bill, as my noble friend Lady Berridge just said. The Wessely review was commissioned by my noble friend Lady May of Maidenhead with the intention of understanding why a disproportionate number of black people were being detained and receiving community treatment orders under the Mental Health Act. I think all noble Lords welcome the idea of including equity in principle, as long as it then feeds through into practice. That is the key here, and my question for the Minister is: would putting the principle in the Bill make a difference to practice? How do we make sure that it makes a difference to practice, rather than simply adding the words or adding the principle? One of the values in the NHS constitution is that “everyone counts”. Does this equality duty go further than that, and would it have a greater practical significance? That is one of the questions we need to dig out and probe the Government on.

The noble Baroness, Lady Tyler, makes an interesting observation with her Amendment 3. The principles were included in the Bill, as the Wessely review argued, to improve clinical practice. This is vital, because we know that the Mental Health Act is the legislation that is used to compel detention in hospital for treatment. This may very well raise awareness of the principles, but once again, how do we make sure that this is applied? We have to keep pushing this point, although I will not repeat it again, of making sure that this gets fed in to practice in the clinical setting.

I also note the amendments in this group of the noble Baroness, Lady Whitaker. I will not repeat the statistics that she read out about the impact of the lack of or inappropriate support for people with mental health issues or learning difficulties. Of course, it is not difficult to appreciate the complexities. Someone in my close family worked with speech and language therapists in his youth, and I could see the difference it made. It is almost too obvious to say, but how do you get your needs across if you cannot communicate them, or your needs are not understood by the person who is supposed to be offering treatment? As the noble Lord, Lord Patel, mentioned, this is included in the Explanatory Notes, but how do we make sure that it gets into the Bill and into practice? Obviously, it is a problem that is acknowledged by the Government, or it would not be in the Explanatory Notes, but why have the Government chosen not to go any further on this issue?

I was very struck by what the noble Baroness, Lady Murphy, said about Amendment 49 and her concerns. Will the Minister address that debate? Of course, we all want to make sure that patients feel that they are understood. We know that patients have to be supported as much as possible to make sure they get their point across and that they are understood, in order to give them adequate treatment, but I noted the concerns of the noble Baroness, Lady Murphy, even though the noble Lord, Lord Patel, intervened. Have the Government taken a view on this or does the Minister need to write to us? I look forward to her comments.

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

My Lords, I feel it necessary to start, instead of talking about the Bill, by offering our condolences to the noble Baroness, Lady Hollins, on the very recent loss of her dear husband, and to thank her, as I know all noble Lords will do, for her close engagement on these reforms over many years. I say to the noble Baroness, who said she would be watching if she could, that we absolutely understand why she cannot be with us today. We miss her and I know that the thoughts of all noble Lords will be with her at this very sad time.

If I may make a few general points, as we know, this legislation has been in development for many years. I put on record my thanks for the collaborative and constructive nature of that work and the discussions I have held in my post over the past few months with Peers on all sides of the House. I extend my appreciation to the former Prime Minister, the noble Baroness, Lady May of Maidenhead, for her highly significant role in commissioning the independent review which informed this Bill and to Sir Simon Wessely and all those who worked on this landmark review, which provided a blueprint for this Bill. Like other noble Lords, I am very pleased to have got to this point.

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[Baroness Merron (Lab)]

I am grateful for my noble friend’s intervention. I will later make specific points about speech and language therapists.

The revised code of practice will give guidance for decision-makers and those involved in care and treatment on how to support individuals with communication needs to make sure that their voices are heard. Following Royal Assent, we will draft, and consult on, a code of practice, and it will be laid before Parliament. In addition to the code, we will lay secondary legislation to support the reforms set out in the delegated powers memorandum. I am committed to sharing papers setting out further details on this, including what we expect the content of care and treatment plans to cover, some of which is highly relevant to this debate.

Amendment 3, in the name of the noble Baroness, Lady Tyler, and also spoken to by the noble Lord, Lord Kamall, would mean that the individuals and organisations referenced in Section 118(1) of the Mental Health Act 1983 must have regard to the code of practice when making decisions. It seeks to probe whether the principles set out in the table in Clause 1 of this Bill—under new Section 118(2B) of the 1983 Act —will be statutorily binding. Practitioners are already under a statutory obligation to take account of the code when making decisions under the Act. Anyone who must have regard to the code of practice under Section 118(2D) must therefore also have regard to the statement of principles that the Secretary of State must include in the code when carrying out specified functions under the Act. That includes all those referenced in Section 118(1).

The Government expect practitioners to follow the code. Anyone seeking to depart from it must have compelling reasons for doing so. Reasons for any departure must be recorded clearly, as courts have the power to scrutinise such reasons to ensure that there is sufficiently convincing justification for not following the code.

I believe that this is the right approach, because relevant individuals and organisations must have regard to the code and, in turn, the principles. But the system is not so inflexible that a principle must be followed irrespective of the circumstances, because there could be very rare cases whereby it could create a risk that an individual is not being treated according to their own particular needs, which is not the intention of the Bill.

[Lord Scriven (LD)]

I think the Committee would understand that if it was to do with a therapeutic intervention. This is about the principles according to which clinicians and others have to work when dealing with the Act. First, can the Minister enlighten the Committee as to which principles, as a framework, would not be suitable for a particular patient? It is a principle. Secondly, my noble friend tabled this amendment because case law on codes of practice in the public sector goes back to 1998 and Regina v Islington Borough Council, in which the court made it very clear that public bodies have the right to deviate on admissible grounds where there is good reason. I can see no reason, unless the Minister can give one, why deviating from a principle is acceptable. That is why my noble friend wants the principles to be in the Bill. I could understand if it was a restrictive practice, but it is not; it is a principle.

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[Baroness Butler-Sloss (CB)]

To add to what the noble Lord, Lord Scriven, has said, I am having a problem understanding why the code is not statutory.

[Baroness Merron (Lab)]

I thank noble Lords for their interventions, for which I am grateful. They give me the opportunity to say now what perhaps I should have said at the outset: I will of course reflect on all the points that are raised as we move forward. I will be honest and say that I am not sure that what I am about to say will do justice to the points that have been raised. Overall, the real concern is about making very complex legislation even more complex. We are wrestling with our attempt to update the Mental Health Act—we are not starting from scratch. That is the point I would like to like to move on to.

The noble Baroness, Lady Tyler, raised a comparative point about the Mental Capacity Act and asked why, if that could include principles, it is not possible for the Mental Health Bill to. To extend what I have just said, it is because the Mental Capacity Act was structured around principles from the outset when it was drafted and did not have to meet the challenge that we are trying to debate today. As I said, we are currently looking at amending the existing Mental Health Act, which has not been designed or structured around statutory principles. In my language, I would say that we are starting from an entirely different place.

[Baroness Berridge (Con)]

I hate to interrupt the Minister’s flow, but we are going to come back to the code of practice again and again. Can she outline whether we will get to see a draft of that code? If the argument from the Government is that it needs to be in the code and not on the statute, it would be very helpful to see a draft code of practice before Report, at the very latest.

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We should bear in mind that some of us are very worried that aspects of the Equality Act are currently under attack, sometimes from members of the medical profession. Does the Minister accept that that is therefore not an adequate protection and that the evidence before us says as much? In answering, will she perhaps respond to my noble friend Lord Scriven’s point and give us examples where people have been able to take action by reference not to the law but to a code of practice being ignored, because I am not aware of one?

[Baroness Merron (Lab)]

I thank noble Lords for their interventions. I will take the point from the noble Baroness, Lady Berridge, first. Following Royal Assent, we will be drafting and consulting on a revised code of practice, which will be laid before Parliament. We will be working with key partners to ensure that everyone is trained in the new Act before the first major phase of reforms. I hope that that will be helpful.

I hear the disappointment in the comments of the noble Baroness, Lady Barker. On her request for specific examples, I will need to write to noble Lords on that. I hope noble Lords realise that not having the principles in the Bill, as the amendment refers to, does not mean that there is less intention that they apply. For me, it is about the way of getting there, rather than the commitment to it. However, I hear the question about that point.

Amendment 49, on the matter of speech and language therapists, is in the name of my noble friend Lady Whitaker, supported by the noble Lord, Lord Patel, and my noble friend Lord Bradley. I turn first to the question raised by my noble friend Lady Whitaker. It is true that not all speech and language difficulties or differences would count as a disability under the Equality Act 2010, so my noble friend makes a relevant point.

The definition of who can and cannot be approved as an approved clinician was spoken to by the noble Baroness, Lady Murphy, and the noble and learned Baroness, Lady Butler-Sloss. That definition is set out not in primary legislation but in instructions issued by the Secretary of State, under the power in Section 12ZA of the current Mental Health Act. These instructions have the same status as secondary legislation, so it is our belief that it would not be appropriate to specify in primary legislation that speech and language therapists can be approved clinicians, because all other professional groups are covered only in the instructions.

For that reason alone—but noble Lords should bear with me—we will seek to reject this amendment. However, I can commit that we will be revising the statutory instructions under Section 12ZA following the passage of the Bill, and we are very happy to consider extending the criteria to include speech and language therapists. I offer an invitation to the royal college to discuss this matter with the department and to consider how it can work to support and encourage those of its members who may be interested in this role.

I am aware that time is not on my side. However, a number of amendments in this area have been tabled—

[Lord Kamall (Con)]

I wonder whether I can be of help to the Minister. The timing is advisory so, if there are important points that the Minister wishes to make, she should please go ahead.

[Baroness Merron (Lab)]

I have never had so much encouragement to carry on speaking. Noble Lords will be glad to know that the flashing clock always makes me very nervous. I thank the noble Lord, Lord Kamall.

[Baroness Murphy (CB)]

Can I just add to what the noble Lord, Lord Kamall, just said? I have never before sat through a Committee where the Minister has been restricted in going beyond any advisory time. She should say what she darn well likes. She may have to respond to an awful lot of complicated spots in this; there is no reason at all why she should not carry on, in my view—and that of everyone else in the Committee, I think.

[Baroness Merron (Lab)]

I am extremely grateful to the noble Baroness for helping me out there.

I referred to my invitation to the royal college. Given this commitment to pursue these changes, that will be subject to agreement with the royal college. I hope that will be of assistance to noble Lords.

I turn now to Amendment 52 in the name of my noble friend Lady Whitaker, supported by the noble Lord, Lord Patel, and my noble friend Lord Bradley. It seeks to ensure that clinicians consider a patient’s communication needs and make reasonable adjustments as part of the new clinical checklist; this requires clinicians to consider a number of matters when deciding on a patient’s treatment, with the aim of making treatment more patient-centred.

We share the goals of this amendment. However, the checklist already requires the clinician to take steps to assist and encourage the patient to participate as fully as possible in the decision-making process. We consider assistance to include making reasonable adjustments to account for a patient’s communication needs, which is something that noble Lords have rightly raised as being of concern. We very much intend to make this clear in the code of practice, which will already provide specific guidance on the need to make reasonable adjustments under the Equality Act. For example, the clinician should provide information in an accessible form, perhaps by involving an interpreter, a signer or someone who can communicate via the person’s preferred communication method.

My noble friend Lady Whitaker has also tabled Amendment 60, supported by the noble Lord, Lord Patel, and my noble friend Lord Bradley. It seeks to ensure that the new statutory care and treatment plan introduced by the Bill covers

“information about a patient’s communication disability, difficulty, or difference”,

and how these might be identified and supported. The Bill makes it clear that a statutory care and treatment plan is a plan made in accordance with regulations, so we intend to set out in regulations that a patient’s plan must include, among other things, information that is important for the treating clinical team to be made aware of during the patient’s detention. This is to encourage the treating clinician, as noble Lords have spoken about, to consider the individual needs of patients—including communication needs—so that the appropriate reasonable adjustments can be made. A record of how their needs will be supported should be evident throughout their plan, which should, as far as possible, be developed in consultation with the patient and others, such as their family members.

Regarding the identification of any communication needs, as already set out in the Mental Health Act code of practice under the Equality Act, mental health professionals should already be identifying and making any reasonable adjustments to account for a person’s communication needs. Where applicable, a patient’s care (education) and treatment review may also identify and make recommendations about a patient’s communication needs. We intend to set out in regulations that these recommendations must be attached to the patient’s statutory care and treatment plan, so that they can inform planning and delivery of care. I hope that this will reassure noble Lords that the patient’s statutory care and treatment plan should cover any communication needs and how they will be met, but in reflecting on this debate I will ensure that the actions we are proposing take account of this.

Amendments 112 and 114, tabled by my noble friend Lady Whitaker, would require managers of hospitals or registered establishments to provide information in an accessible format when discharging duties under Clauses 39 and 41 to give information on complaints to detained and conditionally discharged patients. I agree that it is important that all patients can access information about their detention, including the complaints process, and in a format that is accessible to them. However, the clauses are already drafted with the overriding obligation that the patient is helped in whatever manner is practical to understand the information being given to them. Therefore, it is unnecessary to add the words in the amendment proposed by my noble friend. Additionally, hospital managers have an existing duty under the Equality Act to make reasonable adjustments based on disability, which is the legal basis for ensuring that information for patients is accessible.

I reiterate that I understand that communication needs will not always be related to the letter of the Equality Act. There is already guidance in the mental health code of practice on how a patient’s communication needs should be considered when providing information on complaints. When we come to revise the code, we will engage with stakeholders to explore whether further guidance on the complaints process, including how information on complaints should be provided, is required.

Amendment 118 in the name of my noble friend, supported by my noble friend Lord Bradley and the noble Lords, Lord Patel and Lord Bourne, seeks to ensure that the advance choice document template is available in a format that the service user can understand. We strongly agree with the principles of this amendment and are committed to mitigating any barriers that people may face to creating an advance choice document or making their wishes and feelings known in advance. Where a person wishes to make an advance choice document, our intention is that they are given a standard template to complete, alongside supporting guidance and, where the individual wishes to receive it, the support of mental health practitioners. The template should prompt the individual to think about the sort of things they may wish to consider and decide in advance of becoming unwell. We will work to develop these resources.

We also plan to set out in guidance to health commissioners that these resources and the support provided by mental health practitioners must be delivered in a way that is accessible to individuals and that responds to their needs. That will be in line with the Equality Act and the public sector equality duty. Of course, if a person wishes to create a record of their wishes and feelings in another format that is easier, they absolutely may do so. We have purposefully made it that individuals do not need to complete a prescribed form in order for their advance wishes and feelings to be considered at a later stage. I agree with the need and hope that this will provide maximum accessibility and increase patient voice and autonomy.

Finally, Amendments 119 and 126, tabled by my noble friend Lady Whitaker and supported by my noble friend Lord Bradley and the noble Lord, Lord Patel, seek to ensure that the support provided to people to create an advance choice document is responsive to the needs of people with a

“communication disability, difficulty or difference”.

I agree that is important. To achieve this, it is important that support and information around advance choice documents respond to people’s needs individually, so that no one is unfairly disadvantaged. That includes communication needs.

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[Baroness Merron (Lab)]

My Lords, I am most grateful to noble Lords across the Committee for their contributions. I will start by referring to the points raised by the noble Lord, Lord Scriven. A range of views has been expressed today on the matter of detention. The noble Lord asked what provision will be in place to ensure that we are not using some kind of backdoor, and that is a very good general question for us to hold in our heads. It is a very important matter, given the very poor outcomes we have seen for those with a learning disability and for autistic people under the current Act. I know this is something that has really exercised noble Lords—rightly so, in my view.

The noble Lord, Lord Kamall, is quite right to remind me of comments I made from that Dispatch Box, which I still stand by. I have concerns, as I know he does too. The proposals here are intended to address the matter of improving outcomes. The debate today has been extremely helpful and will allow me to reflect on where we need to go in respect of these. I am also grateful for the range of wider topics raised in this group—for example, on the importance of the community sector—and I look forward to moving on to these when we come to subsequent groups later today.

Let me first address Amendment 4 and the notice to oppose Schedule 1, tabled by the noble Baroness, Lady Bennett of Manor Castle. Currently, a person with a learning disability can be detained for treatment under Part II, Section 3 of the Mental Health Act when their learning disability

“is associated with abnormally aggressive or seriously irresponsible conduct”.

I heard what the noble Baronesses, Lady Browning and Lady Berridge, said. The noble Baroness, Lady Browning, used the word “meltdown”, and she has spoken to me about this before. I know that not all noble Lords like that word, which is why I put it in quotes, but the point is well made and the noble Baroness has explained to me about understanding a person’s conduct. It is also the case that an autistic person can be detained under Section 3 on the basis of mental disorder.

While the independent review found examples where use of the Act can deliver therapeutic benefit, it also found that hospital detention—a number of noble Lords spoke about this—can be detrimental for people with a learning disability and autistic people, due to exposure to environments or experiences that are completely insensitive to what I would call reasonable adjustments. This obviously causes stress and leads to behaviour considered to be challenging. We have heard that it is too often the case that people with a learning disability and autistic people are being inappropriately detained due to a crisis—which may be a better word in this instance—that has arisen due to a lack of community support, rather than for treatment of a mental health condition. That is unacceptable and the point has been extremely well made, both in the Chamber today and on earlier occasions.

The Government are committed to ensuring that hospital detention happens only when an individual has a mental disorder that warrants hospital treatment that has a reasonable prospect of providing a therapeutic benefit. It should not be some form of punishment. Schedule 1 and Clause 3 will change how the Act applies to people with a learning disability and autistic people by introducing new definitions for “psychiatric disorder”, “learning disability” and “autism” in the Act, and making amendments using those definitions throughout the Act. These amendments remove, for the purposes of Part II of the Act, learning disability and autism from the scope of conditions for which a person can be detained for compulsory treatment under Section 3. I hope that will be of reassurance to the noble Lord, Lord Kamall, and other noble Lords.

The noble Baroness, Lady Bennett, argued that the Bill is non-compliant with the UN Convention on the Rights of Persons with Disabilities. The measures in the Bill give patients greater choice, enhanced rights and support, and seek to ensure—I know that noble Lords want to probe this—that everyone is treated with dignity and respect throughout their treatment, and that the treatment is appropriate to the situation. It is the view of the Government that the Bill is compatible with the convention. Detention under the Act is not based merely on the existence of disability: that is something I really want to emphasise. Detention is risk-based. Detention and other compulsory measures are permitted only where they are justified by the risk posed by a person’s mental disorder and, through the Bill, I hope that we are very much strengthening the criteria for detention. We will come back to this later in Committee.

Amendment 4, tabled by the noble Baroness, would leave out Clause 3 and put in a new definition of mental disorder to remove learning disability and autism from the scope of the Mental Health Act entirely. This would mean that a person could not be dealt with under any section of the Act on the grounds of learning disability or autism alone. We very much recognise the arguments for removing these conditions from the scope of the Act, but there could be unintended consequences in the removal of critical safeguards. I know that the noble Baroness does not wish to cause that effect.

For example, the Bill retains the ability to detain people under Part II, Section 2, for a maximum of 28 days, for the purpose of assessment. That can be necessary both for the safety of the individual and the public, and for a clinician to understand fully whether a treatable mental health condition is the cause of the behaviour. I suggest that this is particularly important when considering conditions associated with high rates of co-occurring mental health conditions. Without these powers, there is a risk that the mental health needs of these groups of people are not identified or met appropriately, leading to further health inequalities for this group of people. I know that is not something that noble Lords would wish.

[Baroness Barker (LD)]

I have not spoken in this debate so far, but I have listened intently to everything that everybody has said, including the noble Baroness, Lady Murphy. Members of the Select Committee will remember—they could not forget—the evidence given to us by particular witnesses who have autism and have been through the trauma of being detained. They made to us, unforgettably, the point that there are some people with autism and learning disabilities for whom detention is an aggravating factor.

I happen not to agree completely with the noble Baroness, Lady Bennett, that there should be an end to all detention, although I have some sympathy with her arguments. I believe there are people for whom detention is necessary—both for them and for the safety of others—but they should be held in mental health facilities and not the criminal justice system.

I listened intently to the noble Baroness, Lady Murphy. I understand that it may be absolutely correct to define people with autism and learning disabilities as having a disorder, but we have moved on over 20 or 30 years to understanding that their manifestations and treatment are different from those of other mental health conditions. There is therefore a problem in having the diagnosis and treatment carried out by the same people. I hoped that she would explain, but she did not, why keeping people within the definition would improve their care.

[Baroness Barker (LD)]

I am sure that the noble Baroness would. Does she accept that for some people, particularly those with autism and learning disabilities, being held in conditions that are noisy, filled with light and full of people they do not know—in which they are made to feel completely powerless and do not know what will happen to them next—will be a contributory factor to their illness? I make that point to the noble Baroness, Lady Merron. She talks about choice, but what increased protections are there in this Bill for people with autism or learning disabilities who find themselves in detention, which is an aggravating factor causing them to be wrongly diagnosed?

[Baroness Merron (Lab)]

I will be pleased to come back to that point. I think agreement broke out for a moment, which I would share, on the fact that detention takes many forms. It is about getting the right form and being sensitive to the needs of the individual, which is what the Bill is all about. I am grateful for those comments.

To pick up my point about the expert consultation that has taken place, a decision was taken to retain the ability to divert people who are autistic or have a learning disability, who have committed a crime, from prison to hospital under Part III of the Act. Without this safeguard, the only alternative to detention in hospital is detention in prison. Noble Lords have referred in this group to how, often, this would be inappropriate in meeting those people’s needs and would exacerbate and manifest distress. On balance, we believe it is right to retain the ability to divert such patients to hospital, where they are much more likely to access the right kind of support and care that they need.

The noble Baroness, Lady Bennett, raised concern about resourcing implications for local authorities. I refer her to the impact assessment, which sets out anticipated costs, including a breakdown of costs for councils. I assure her that we will do further work with MHCLG to assess any new burdens on local authorities created by the Bill. We are very alive to that situation.

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[Baroness Browning (Con)]

The Minister will not be surprised to hear that I like what she just said. Is there no way she can put that in the Bill under a government amendment?

[Baroness Merron (Lab)]

I am grateful for the invitation, as always. Government amendments will be considered as we progress through Committee, but I say that as a broad point, as I know the noble Baroness understands.

The intention of the provisions in the Bill on registers and commissioning is that people with a learning disability and autistic people are not detained but supported in the right way. The proposed changes to Part II, Section 3 will be commenced only where there are strong community services in place.

[Baroness Berridge (Con)]

I am aware of how much time the Minister has given and how generous she has been in allowing interventions. If she is minded on Amendment 5, can she outline whether she is proposing that there would be the special tribunal that the Joint Committee outlined? If so, how would she then deal with these issues for under-16s in respect of DoLS and for vulnerable adults? When there is no legal basis at all, it is then left for clinicians to detain anybody after the 28 days.

[Baroness Merron (Lab)]

I became a little worried, listening to the noble Baroness, Lady Berridge, that perhaps I had been a bit too generous.

[Noble Lords]

No.

[Baroness Merron (Lab)]

I am sure that I have not been generous enough. I cannot give a commitment to government amendments on any of these areas. As noble Lords will be aware, that is the purpose of the kind of debate that we are having in Committee. However, we will certainly return to these matters.

The Mental Capacity Act protects people subject to arrangements that may amount to a deprivation of liberty in hospitals, care homes and other settings, by allowing a deprivation of liberty only when it is necessary and proportionate. There are instances when it is important that the Mental Capacity Act can be used to protect and to safeguard people where appropriate, and we do not want to lose that aspect.

The concern about the amendment is that it might have the effect of undermining decision-making, or of denying a specified group of people the right to protections under the Mental Capacity Act—although I know that this is not intended. I will give an example. Where a person lacks capacity but does not have a psychiatric disorder that requires treatment, there may be elements of that person’s care plan and arrangements that require deprivation of liberty safeguards to ensure that they can access the community safely and maintain a safe home environment. Similarly, certain specialist community placements are also registered hospitals, so the proposed amendment could unintentionally—I stress “unintentionally”—remove such provision as a viable community-based option, where the individual lacks capacity but would benefit from this placement as an alternative to in-patient care.

The noble Baroness, Lady Berridge, rightly made some comments about the statistics for LDA detention rates. I assure your Lordships that the data and statistics being referred to are absolutely key. They are collected and published, and they will continue to be monitored. If there are any matters where the noble Baroness or other noble Lords feel that we should go further, I would be very pleased to receive their comments.

On the point raised by the noble Baroness, Lady Berridge, about the use of High Court deprivation of liberty safeguards for children, I will refer to the action of the previous Government, which I hope will be seen as very helpful. In 2023, a task and finish group was established called “Improving cross-sector support for children in complex situations with multiple needs”. It was made up of a number of central government departments, operational local agencies and representative bodies, the NHSE and the Youth Custody Service to represent the voice of children and young people, as well as the Children’s Commissioner. This group has been developing a cross-sector response to help ensure that there is suitable provision in place for children and young people with complex needs who are at risk of being deprived of their liberty. To that point, I will take a particular interest in the task and finish group and its work, and we may come back to it.

[Baroness Barker (LD)]

I thank the Minister for giving way again. Listening to the noble Baroness, Lady Browning, set out and explain her amendments, it seems to me that they require the people making the decisions about whether to detain somebody to be clearer about which law they are using to decide to detain at a particular point for a particular person. As I understand it, they are not excluding or preventing the use of either bit of legislation for an individual; they seek just to have greater clarity about which legislation is being used and why, and therefore what protections the person will have. The Minister said that, if these amendments go through, some people will, somehow, be excluded from the correct treatment. Is there a particular group of patients or conditions that are at risk if the amendments tabled by the noble Baroness, Lady Browning, are implemented? Can the Minister give us some examples? Otherwise, I fail to see the logic of what she is saying, given the explanation that the noble Baroness, Lady Browning, gave the Committee.

[Baroness Browning (Con)]

I agree. The amendment seeks to strengthen and to clarify, rather than to make changes that would be completely different to what is intended in the Mental Capacity Act.

[Baroness Merron (Lab)]

I am grateful for the noble Baronesses’ comments. I will come back with some examples before I sit down, because that is a very good suggestion. If I fail to do so, I will gladly provide them in writing.

Amendment 35, tabled by the noble Baroness, Lady Murphy, intends to provide a route to detain people with a learning disability and autistic people who do not have a diagnosed psychiatric disorder. Detention could be authorised only with the approval of the tribunal in “exceptional circumstances”, with power to provide guidance on what those circumstances will be in the code of practice. The amendment seeks to address the needs of those with a learning disability and autistic people, with whom I know the noble Baroness is concerned, where a considerable risk is being posed in the community, but who do not also have a diagnosed psychiatric disorder warranting detention for treatment under Part II, Section 3.

Our clear intent throughout the Bill is that people should be detained beyond Section 2 only when they have a psychiatric disorder that requires hospital treatment. It is our feeling that this amendment runs contrary to that intent. I am also grateful to the noble and learned Lord, Lord Hardie, for his comments on Amendment 35.

We also have some concerns about the scope of the “exceptional circumstances”, which would potentially result in a position no different to the current effect of the Act. It is unclear, in advance of the code of practice being developed, how broadly this might be defined. There would be considerable scope for different, divergent approaches in comparable cases, which, again, I know is not the intent of noble Lords.

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[Interruption.]

[Baroness Merron (Lab)]

I am sure that the noble and learned Baroness’s yawn speaks for many.

[Baroness Butler-Sloss (CB)]

I apologise.

[Baroness Merron (Lab)]

There is no need to apologise.

I am pleased to provide the reassurance that the proposed changes to the Section 3 detention criteria mean that it would no longer be possible to detain someone with a learning disability or an autistic person under Section 3, unless they have a psychiatric disorder. Additionally, the Act already requires a statement of rationale for detention and statutory forms. The registered medical practitioner will have to confirm that the patient meets the criteria for detention, including that they are suffering from a psychiatric disorder requiring hospital treatment and not just that the patient has a learning disability or is autistic. I hope that will be of reassurance to the noble Baroness.

For the reasons I have set out in respect of all the amendments—I thank noble Lords for them—I ask the noble Baroness to withdraw hers.

[Baroness Bennett of Manor Castle (GP)]

I thank the Minister for her rich and full response, and indeed all noble Lords who have taken part in this important debate. It has been long but that has been quite necessary. I thank the Minister particularly for responding directly to my question about the UN Convention on the Rights of Persons with Disabilities. I do not agree with her response but I appreciate that she engaged fully with it, so I thank her for that.

I will not go through and summarise all the contributions, but I just want to make two points, which are perhaps specifically directed to the noble Lord, Lord Kamall, and the noble Baroness, Lady Murphy. A phrase which has been missing from our whole debate is the “social model of disability”. That is the idea that society is discriminatory, and that people are disabled by the barriers in society, not by their difference. That position was endorsed by the Government Equalities Office in 2014, and so far as I know, that still holds, and it is preferred by most disability charities.

I invite noble Lords to consider another phrase in this healthcare space, which is “parity of esteem”. I think that when we come to the social model of disability and physical disabilities, most people have now accepted that if there are only steps and not a ramp, that is a failure of society, not the failure of the person in the wheelchair. However, we have not heard in this debate an acknowledgement of the same parity of esteem—the same approach to mental disability as we have accepted towards physical disability—and we should consider and think about that.

In that context, just to pick up a couple of points from the Minister, she talked about how people with autism or learning difficulties can be detained for aggressive or irresponsible conduct. The Trieste model—if I can call it that—which is being adopted by many countries around the world, asks: “Can we intervene before that point and ask what has provoked that person? Can we intervene before we need to detain someone?” That needs to be very carefully considered.

The other point that the Minister addressed, which I confronted myself with, asking why I did not table the broader amendment that I might have done, is what happens when people get to the point of being a danger to themselves or—I stress that this is extraordinarily rare—a danger to others as a result of a mental disorder. Again, how did people get to that point, and should there not be services and support and community wraparound in the Trieste style? I do not think that any nation or area is saying that it has totally got to that point, but surely we should be aiming at that.

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[The Earl of Effingham (Con)]

My Lords, this group of amendments aim to strengthen provisions for care (education) and treatment reviews—CETRs, as we have heard—for individuals with autism or a learning disability. These amendments collectively aim to address gaps in the current drafting and ensure that the needs and rights of these individuals are fully considered and respected.

This reflects the dignity, respect and patient-centred care principles that strengthen the Bill. Amendments 6 and 12, in the name of the noble Baroness, Lady Barker, highlight the importance of considering housing needs during care (education) and treatment review meetings. A stable, safe and appropriate home environment is a critical determinant of mental health and well-being. Failure to address housing can undermine the effectiveness of care plans, leading to avoidable crises, as the Minister put it earlier, and setbacks that can risk damaging the long-term success of these care plans. Can the Minister please clarify how housing needs will be integrated into the CETRs under the current provisions of the Bill?

Amendments 8 to 10 and 15 to 17 focus on ensuring that the CETR process is inclusive and transparent. These amendments expand the list of those who should receive CETR reports to include the patient, their nominated person, independent mental health advocates and, where relevant, their parent or guardian. These measures should help foster trust and collaboration in the care process and create a more holistic approach to care planning by ensuring that all key individuals are kept informed. Can the Minister please confirm whether the current drafting of Clause 4 sufficiently addresses these inclusivity concerns or whether these amendments are necessary to achieve that goal?

Amendments 19 and 20 address the issue of ensuring that recommendations from CETRs are acted upon. It is not enough for reviews to generate reports and recommendations: there must be a clear and enforceable duty on integrated care boards and local authorities to act on them. Amendment 19 would strengthen this by replacing the current requirement to “have regard to” recommendations with a “duty” to carry them out; while Amendment 20 ensures that “a compelling reason” must justify any deviation from these recommendations.

These amendments reflect the frustration often experienced by patients and families when well-intentioned recommendations are not implemented. A stronger duty to implement recommendations would not only improve outcomes but restore trust in the system. Can the Minister outline how the Government intend to ensure that recommendations from CETRs are indeed implemented effectively?

Amendment 13 highlights the importance of addressing communication needs during the CETR meetings. It is highly welcome that the issue of communication and language has been addressed by so many noble Lords. Effective communication is essential for patient-centred care, ensuring that patients can meaningfully participate in that very care. Ensuring that individuals’ additional or alternative communication needs are met is not merely a courtesy, it is a necessity and a must-have. This group of amendments highlights the importance of a holistic, inclusive and accountable approach to care and treatment reviews. They seek to ensure that the needs of patients, including those related to housing, communication or support networks, are fully recognised and addressed. They also emphasise the need for timely reviews and actionable recommendations backed by clear accountability mechanisms.

His Majesty’s Official Opposition are broadly supportive of the aims of these amendments, and we look forward to the response from the Minister.

[Baroness Merron (Lab)]

My Lords, I am grateful to noble Lords for their amendments and contributions today. It seems a while ago that the noble Baroness, Lady Barker, originally spoke, but I put on record that I hear her frustration about having been here before. I certainly acknowledge that; and I am grateful for the contribution and time that noble Lords have given to this really important matter, so that perhaps, finally, we will not have to keep going where we have been before.

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[Baroness Butler-Sloss (CB)]

I entirely understand what the Minister has just said, although I do not agree with her, but the point she made about other persons is not contained in the clause that I was complaining about.

[Baroness Merron (Lab)]

I am grateful to the noble and learned Baroness for making that point, and I will gladly review this in the light of it.

To return to the specific amendments, they would ensure that the patient, the patient’s nominated person, the independent mental health advocate and the parent, guardian or other person with parental responsibility receive in all cases a copy of the report following a care and treatment review meeting—or a care (education) and treatment review meeting for children and young people. The current drafting of the Bill is intended to make clear that a copy of the review report must be provided to those who have a legal duty to have regard to the review recommendations, so that any recommendations are implemented as appropriate.

We recognise that there may be individual circumstances that mean it is appropriate for the report to be provided to other people, including the patient themselves. For children and young people, this report is most likely to be shared with a parent, guardian or other person with parental responsibility, but it is important that the legislation does not inadvertently create a legal requirement that must be complied with, which would not be appropriate for every person.

A longer list of people with whom the report must be shared, in every case, may increase the chance of an individual withdrawing the consent for a review to be held if they do not wish for some or all the people to see the report. There may also be circumstances in which the report should reasonably be shared with other people in addition to those set out in the amendments—for example, a family member who has been part of the review process with the patient’s consent but is not the patient’s nominated person or someone with parental responsibility.

We have tabled a government amendment to make it clear that the arrangements may include provision authorising or requiring a copy of the report to be given to other persons, so that the patient may also ask that a copy be provided to others or decide to provide it to others. Statutory guidance will help assist the responsible commissioner when exercising its functions, including when considering other persons who are to receive the report. We wish to allow flexibility for this, so that individual circumstances can be taken into account based on the needs of the patient and their wishes, rather than by providing a prescriptive list of people to whom the report is to be sent in every circumstance.

[Lord Scriven (LD)]

For clarification, is the Minister therefore saying that the Government’s amendment will lead to some statutory instrument, or will it be just at the discretion of the Minister to determine a list and change it without any scrutiny?

[Baroness Merron (Lab)]

I am approaching this without going down the amendments’ route of having a fully prescriptive list, which might have unintended consequences.

[Lord Scriven (LD)]

I really need to understand the intent of the Minister’s Amendment 17

“authorising … a copy of the report to be given to other persons”.

How do the Government intend to draw up that list, to change it and to make it public, so that people know that they are appropriate persons and might be able to get the report?

[Baroness Merron (Lab)]

I hope it helps to advise that the responsible commissioner will be key to all that. I emphasise the need to design around the patient and their needs. If there are further points that I need to look at on this, I would be very pleased to. I am grateful to the noble Lord for raising it.

Amendments 10 and 17 are technical and minor government amendments that make it clear, for the avoidance of doubt, that the responsible commissioner may make arrangements for a care and treatment review report—or a care (education) and treatment review report for children and young people—to be provided to persons other than those listed in the clause. They could, for example, be those who have an interest in the recommendations because they are involved in the review process, such as an independent mental health advocate, a nominated person or a professional involved in the patient’s care and treatment. This would be subject to the patient’s consent. We believe that this is important to clarify, since the review process is likely to involve more people than those who are listed in the legislation, although this will vary according to the individual and their needs and circumstances.

In addition, the Bill makes specific provision to clarify which persons and bodies are to receive the report in every case to ensure that they can comply with their duty to have regard to the review recommendations. I hope that these government amendments find favour with noble Lords.

Amendments 11 and 18 were tabled by the noble Lord, Lord Scriven, who raised the point that around a third of people have no CETR or CTR. My response is perhaps to provide the assurance that that is exactly why we are putting them on a statutory basis. It seems that Amendments 11 and 18 are intended to reduce the maximum amount of time between CTRs for adults and CETRs for children and young people from 12 months to six months following a patient’s initial review meeting. These amendments would apply to children and adults.

I listened closely, as I have listened closely to all comments from noble Lords, but we believe that these amendments are somewhat unnecessary. Current drafting provides that review meetings take place at least once in a 12-month period, in line with the maximum timeframe within NHS England’s policy and guidance. This is in addition to the requirement that arrangements must be made for everyone to have a review promptly upon admission, within 14 days for children and 28 days for adults. Commissioners should use their judgment to determine the frequency of subsequent reviews, in line with the specific needs of the patient. Patients, their families and advocates can also request a review meeting at any point.

There will be statutory guidance to provide commissioners with further information on factors to consider when determining whether more frequent reviews should take place. I understand the noble Lord’s point, but I hope that helps. For example, it is current practice that children under 18 have a review meeting every three months, and this would be articulated in the guidance. We consider it preferable to set out this information in statutory guidance, which can provide detailed case studies. That would not be possible if we set it out in the same way as primary legislation, not least because guidance can be readily updated in line with emerging best practice, including on frequency and considering particular circumstances.

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[Lord Scriven (LD)]

I have listened very carefully to the Minister about flexibility. Why is 12 months in the Bill? All I am trying to do is to change a statutory timeframe that the Government have put in the Bill to six months. That flexibility is not there because 12 months is in the Bill. I am trying to move that fixed point from 12 months to six months, regardless of what guidance says.

[Baroness Merron (Lab)]

Yes, I understand the intention, but I refer back, perhaps usefully, to the point I made earlier that review meetings would take place at least once in a 12-month period; it is not a maximum—I think I have got it the right way round. It will be at least once in a 12-month period; it is not that it can be only once in a 12-month period. That is, as I said, in line with the maximum timeframe in NHS England’s policy and guidance.

Amendment 13 tabled by the noble Baroness, Lady Tyler, relates to care and treatment reviews. The amendment seeks to ensure that a patient’s review makes recommendations about ensuring communication needs are met where there are additional or alternative communication needs. That is something we discussed very constructively in the first group and it was referred to by the noble Earl, Lord Effingham. We believe that current drafting already provides for that in the Bill.

As set out in the clause, those meetings are to review any needs of the patient for social care or medical treatment and can make recommendations about whether and how those needs can be met. This should include recommendations about the patient’s communication needs, which may be important in ensuring that their treatment is effective and to support their discharge from hospital. As set out in the clause, a number of named persons and bodies are to have regard to the recommendations of the review. That will give them the appropriate legal weight to ensure that they are considered and that there must be clear reasons if they are not taken forward.

The Bill also introduces statutory care and treatment plans for all patients detained under the Act, excluding those under short-term sections. We plan to set out the required contents of the statutory care and treatment plan in regulations. It is our intention that this includes information about communication needs to enable the treating clinician to consider the protected characteristics and individual needs of the patient, which speaks to the point I made in the first group to my noble friend Lady Whitaker, and to make reasonable adjustments. Regulations will also require that the report from a patient’s care (education) and treatment review is attached to the care and treatment plan so that recommendations are included as part of this.

Finally, I turn to Amendments 19 and 20, tabled and supported by the noble Lord, Lord Scriven, and the noble Baronesses, Lady Hollins and Lady Bennett. These amendments seek to ensure that there is a duty on integrated care boards and local authorities to carry out recommendations from a patient’s CTR, or CETR if the patient is a child or young person, unless there is a compelling reason provided for why a recommendation cannot be carried out. I thank the noble Baroness, Lady Watkins, and the noble Lord, Lord Stevens, for their differing but nevertheless significant contributions.

These review recommendations should be given the appropriate legal weight to ensure that they are given serious consideration. We have decided to include these provisions in the Bill to put the existing NHS England policy on a statutory footing.

The duty to “have regard” is a well-established duty that clinicians, ICBs and other public bodies are used to applying and it already exists within the Act. The noble Earl, Lord Effingham, asked how the Government will ensure that these recommendations are implemented effectively. I hope that my comments will assist the noble Earl. Where effective care and treatment is the central aim, we would expect careful consideration of all recommendations. Where those bodies decide not to accept a relevant recommendation, we would expect them to have very good reasons for making that decision. It is an appropriate duty in this context because we do not intend to place an absolute duty on a body to follow recommendations in every case—that would be incompatible with understanding the individual needs and requirements of the person concerned.

The legislation must not impose unreasonable duties on relevant bodies that they cannot fulfil or where it would be inappropriate for them to do so; for example, if a recommendation was made that was outside of their purview. The Bill already requires that certain named persons or bodies carefully consider the recommendations and give them appropriate weight.

In view of all those comments, I thank noble Lords and ask that they do not press their amendments.

[Baroness Barker (LD)]

My Lords, I thank everybody who has taken part in the debate on this group of amendments. We were, in essence, trying to get answers to the following questions. Who is responsible for drawing up the care plans and for reviewing the care (education) and treatment reviews? Who is responsible for ensuring that what is in those plans is compliant with the law? Who is responsible for making sure that it actually happens? Who is responsible for finding out whether it has not happened? Who carries the can if it has not happened?

At various points in the Minister’s answer, I was quite hopeful, then, towards the end, we went down the slope quite badly, because it turns out that, apparently, duties will not be put on people, and that is highly regrettable. The Minister does not need to explain to the Committee the difference between a statutory code of practice and a statutory instrument; the issue my noble friend was trying to get to is the extent to which Members of this House will see that these plans reflect what was intended in the law and what scope they will have to call it out if they do not.

I am pleased that it will be a statutory code of practice. That is one step up from nothing—it is not great, but it is better. I am also glad that the Minister said that care and treatment plans will be put in regulations. Will those regulations be done under the affirmative or the negative procedure? That is quite important. In light of all our discussions, we in this House should have the chance to examine that at considerable length and, if it is not right, to have a second go at it.

It is always salutary to sit and listen to the noble and learned Baroness, Lady Butler-Sloss, on the subject on which she is quite rightly famous, not just in the House but outside it. I listened to her strong statement. She will know from other discussions that we have had on the wider subject of health that I have said many times, and I believe it to be true, that we have a health and social care system that is openly predicated on people’s families doing much of the work, and that is never more so than when it comes to discharge. She will have heard me bang on about this before, but I have a considerable degree of concern about what happens to people who do not have families or children. We have never done research on hospital discharge, but I suspect that, if people do not have a relative standing by the bed saying, “No. You are not discharging this person because they are not fit to go home”, they end up being discharged far too early, and I suspect they then go back into hospital as acute admissions a result of that.

That said, I understand what the noble and learned Baroness says about the involvement of parents. However, in 10% of cases, the parent is not the right person. We have heard that in evidence before, which she may recall, where young people who have been subject to mental health treatment have talked about problems within their families. Similarly, people under the Mental Capacity Act have sometimes been the subject of overbearing, overprotective parenting that they have found to be detrimental to them. I am not being anti-parent or asking that parents be excluded. Nobody knows better than the noble and learned Baroness that families are complex, and, as the Minister said, we must make sure that there is the scope to do the right thing for a child.

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[Baroness Barker (LD)]

It is getting late, and people wish to have their dinner because they been here a long time. I think we have had a partial response from the Minister. I believe that care and treatment plans and reviewing them are sufficiently important that some of us will want to go away to see whether, on issues that we may not have got technically right, we can come back, perhaps in discussion with the Minister, to satisfy ourselves.

[Baroness Merron (Lab)]

When I review all of the debates, particularly where there are areas where we need further discussion or information, I will be glad to pursue that. I give that assurance to the Committee.

[Baroness Barker (LD)]

I thank the Minister and welcome that. I beg leave to withdraw the amendment.

Prisons: Health Services

Baroness Merron Excerpts

Tuesday 14th January 2025 Lords Chamber

[Baroness Morgan of Drefelin]

To ask His Majesty’s Government what assessment they have made of the provision of health services in prisons.

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

My Lords, a full health needs assessment for every prisoner is undertaken at least every three years by NHS England, which then updates service specifications and commissions appropriate services to ensure that the health needs of offenders are being met. All 19 health service specifications for prisons and other detention environments are currently being updated to ensure that they remain fit for purpose and are expected to be published by March 2026.

[Baroness Morgan of Drefelin (Lab)]

My Lords, I thank my noble friend for her Answer. I have heard first hand, through the work of the charities the Prison Reform Trust and Revolving Doors, about the challenging and degrading experience that some prisoners have had trying to access healthcare. Does the Minister agree that there is a huge opportunity to make progress here with the development of better facilities in new prisons? Does she also agree that it be would a positive thing to include prison healthcare services in ICBs’ commissioning to ensure that people in secure settings have access to the advances and developments that are available in the community?

[Baroness Merron (Lab)]

I certainly agree with my noble friend that there are huge opportunities to improve healthcare for prisoners. On new prison design, I reassure her that all prison design will be fit for purpose because medical architects will be commissioned. That new design includes, for example, medical cells so that as many healthcare needs as possible can be met in prison. On my noble friend’s point about ICBs, it is a retained service, so it is not currently delegated to ICBs. It is the responsibility of health and justice commissioners to collaborate closely with ICBs to ensure continuity of care. The electronic referral service means that patients in prison can have access to the developments to which others in the community have access.

[Baroness Finlay of Llandaff (CB)]

My Lords, a quarter of a century ago, I worked with the then Minister for Prisons following the difficulty we had releasing a shackled remand prisoner. The recommendation was that every prison should have a link with a hospice service in their area to ensure appropriate care, particularly for prisoners who cannot be transferred out of prison and who may wish to die in their cell, with their cellmate providing some of the support for them as they are dying. Can the Minister tell us how many prisons actually have such links?

[Baroness Merron (Lab)]

I thank the noble Baroness for raising such an important point and for having worked on this in the past. I will need to write her with the exact figures, but we do know that more needs to be done to address health issues. However, we are keen to ensure, and are working towards making sure, that healthcare for prisoners, whether at the end of their lives or earlier, is appropriate and meets their needs, whichever is the right way to do it. Great strides have been made in that regard.

[Baroness Manzoor (Con)]

My Lords, the Minister will know that the most common diseases in prisons are diabetes, high blood pressure, HIV and mental illnesses. What are the Government doing to ensure that psychosis resulting from the use of illicit drugs is being controlled effectively, so that there are not more cases of psychosis and mental illness in our prisons?

[Baroness Merron (Lab)]

Substance misuse in prison, to which the noble Baroness refers, is of course a major issue, and prison security has a crucial role to play in reducing it. I should also say that the use of illegal drugs can impact on routine healthcare for all prisoners, as resources have to be directed to the more immediate cases. Noble Lords may remember that we recently had delegated legislation to ensure that nasal Naloxone could be administered, including by prison staff, to prevent opioid-induced emergencies. All these things will help, and substance misuse support is available in all prisons in line with the national service specifications, but we are working across government to see what more we can do. It is a big issue.

[Baroness Burt of Solihull (LD)]

My Lords, many of the issues preventing prisoners getting equivalence of care with non-prisoners clearly relate to access to hospitals and health specialists. As we know, delays can exacerbate conditions. Will the Government ensure that the Nuffield Trust recommendations on improving transparency, prisoner escort numbers, reviewing the supply of prison escorts and increasing access to out-patient services via telemedical services are implemented as fully as possible?

[Baroness Merron (Lab)]

The use of technology is hugely important in all areas, particularly in respect of prison services, as the noble Baroness says. There is a policy specifying that escorts must consist of at least two prison officers, with at least one being of the same gender as the prisoner unless there are exceptional circumstances. I take this opportunity to say that every effort is made to ensure that female staff support women, particularly where appointments are specifically related to services such as gynaecology. It is very important that we are aware of the possibility of retraumatising women prisoners, and we have been particularly mindful of that in relation to escorts.

[Lord Kamall (Con)]

I start by thanking the noble Baroness, Lady Morgan, for sending me a briefing in advance of this Question. She rightly and importantly highlights that cancer outcomes for prisoners are poorer than for the rest of the population, while the cost of services is greater. However, given that we will be debating the Mental Health Bill later today, I want to ask a related question. Over 30% of prisoners have a learning disability, so what steps are the Government, the NHS and the Prison Service taking to protect and care for prisoners with learning disabilities? They may be there partly as a result of their learning disability, and while in prison are often at their most vulnerable. What care is there for prisoners with learning difficulties in order to protect the public and reduce the risk of reoffending when they are released?

[Baroness Merron (Lab)]

As the noble Lord rightly says, the Mental Health Bill is in Committee this afternoon and I know we will refer to that. Certainly, the reforms in the Bill will speed up access to specialist in-patient care and treatment, in particular by introducing a statutory 28-day time limit for the transfer of patients from prison and other places of detention to hospital. On particular needs, which may be learning disability and autism, as I know noble Lords are aware, the Mental Health Bill is very focused on ensuring that people are being cared for in the right places in the right way, and that in places of detention people are being not just held but supported and their healthcare needs met.

[The Lord Bishop of Gloucester]

My Lords, women in prison have very specific health needs. Will the new women’s justice board look at ensuring that health and social care services across the women’s estate are consistently gender-specific and sensitive to women’s protected characteristics?

[Baroness Merron (Lab)]

I can give that assurance to the right reverend Prelate, and I certainly agree about the particular needs of women in prisons. It is perhaps helpful to tell your Lordships’ House that new women’s health and well-being hubs will begin in all 12 female prisons from 1 April.

[Lord Woodley (Lab)]

My Lords, it is very well known that IPP sentences have broken the mental health of hundreds of prisoners. Does the Minister agree that it is the responsibility of the state to help fix the damage caused by these torture sentences, and that greater resources are needed for medical treatment for and support of IPP prisoners?

[Baroness Merron (Lab)]

I know that the Ministry of Justice is also looking at this, and my noble friend is certainly right to make that point.

Adult Social Care: Long-term Workforce Plan

Baroness Merron Excerpts

Monday 13th January 2025 Lords Chamber

[Baroness Pitkeathley]

To ask His Majesty’s Government what steps they are taking to develop a long-term workforce plan for adult social care, similar to the NHS workforce plan.

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

My Lords, as the social care system in this country is failing, we are therefore launching an independent commission into social care to gain cross-party consensus and lay the foundations for a national care service. The commission will look at how we recruit, retain and recognise the workforce, building on work that is already under way to provide a career structure, to give care professionals greater skills and to legislate for the first ever fair pay agreements.

[Baroness Pitkeathley (Lab)]

I thank my noble friend the Minister for that response and remind her that, when it comes to social care, time really is of the essence. Does she agree that one of the real problems we face is the great difference in status between those who are employed in the NHS and those who are employed in social care? Could next steps, therefore, including the work of the commission, include looking towards developing a workforce that is much more flexible, so that it can actually work across both disciplines—for example, working with a patient in hospital and following them when they are discharged into social care—for the benefit of patients, users and their families?

[Baroness Merron (Lab)]

My noble friend is right that it is important that we have a workforce built around the needs of patients, rather than patients having to be worked around the needs of the workforce. I certainly hope and intend that, as we go forward, we will see much more of this flexibility. I share her view that time is of the essence and I also know that my noble friend and your Lordships’ House also understand that it is very important that we get this right.

[Lord Scriven (LD)]

My Lords, the turnaround rate for social care staff was about 30% last year, so retention is clearly an important issue. However, the Government have not helped the situation since July by cutting £115 million from the adult social care training budget. What will the Government do to mitigate this cut and try to help retention within such a vital service?

[Baroness Merron (Lab)]

Retention is absolutely crucial. I was looking—as I know the noble Lord also does—at the vacancy rates and they are currently running at some 131,000. However, I was interested to note that they are not actually the best measure of capacity, or lack of it, because those vacancies can reflect new roles and short-term vacancies because of anticipated staff turnover. So I have had to rein myself in when looking at the relevance of vacancy rates.

On retention, there is a whole range of factors. In the immediate, I say to the noble Lord that we are professionalising the workforce by expanding the national career structure and have developed and launched a level 2 adult social care certificate qualification.

[Lord Kamall (Con)]

My Lords, as the Government and the NHS introduce new workforce patterns to take account of changes, surely they should also take account of advances in technology. Recent years have seen the successful testing of virtual wards in the NHS to treat and monitor patients who can be discharged from hospital but who require further care. They can be monitored in their home, freeing up capacity in hospitals. Given this, what are the Government and NHS doing to extend virtual social care to monitor care for social care patients? It would allow them to remain in their home for longer, where they are more comfortable, and it could be one of the many ways to alleviate workforce shortages in the social care sector.

[Baroness Merron (Lab)]

I myself have seen some tremendous examples of the use of technology in allowing people to be in the right environment for themselves and their situation. I assure the noble Lord that we are continuing to work to develop medical technology, not just getting it rolled out and applicable but developing new medtech where necessary.

Perhaps I could use this opportunity to make an allied point. We have also published new guidance on safe delegation to care staff, which I hope will also help professionalise the workforce. We are working to support that across the country. That includes, for example, having care staff taking blood pressure. These are simple but obvious measures that I think work for everybody.

[Lord Laming (CB)]

My Lords, the Minister will realise that the workforce in social care is not as varied as in the National Health Service. However, that is not to underestimate the fact that there are staff working in clients’ homes, day centres, residential units and office-based organisations. Will she ensure that, when the workforce is being considered in social care, it will be considered in the round and not just in a narrow way?

[Baroness Merron (Lab)]

I can give that assurance to the noble Lord, and I am glad he has identified to your Lordships’ House the wide range of circumstances in which the workforce might be. For the benefit of your Lordships’ House, I should add that, in their manifesto, the Government made a commitment to

“ensure the publication of regular, independent workforce planning, across health and social care”.

We are currently developing advice on the options about how to fulfil this commitment for adult social care, which will take account of the point the noble Lord made.

[Lord Turnberg (Lab)]

My Lords, one of the major problems is that most care workers are employed by privately owned care homes, both large and small. Many of these employees are on zero-hour contracts—it is a mess. How does one ensure that we have a national workforce plan if we have all these workers in various organisations? We must bring them all together and have a centrally regulated qualification that is nationally recognised. I hope I am not boring my noble friend by asking the same question: when are we going to get a nationally recognised qualification and registration?

[Baroness Merron (Lab)]

My noble friend is never boring and certainly does not bore this Minister. I very much take the point about the difference between the social care workforce and the NHS workforce, because the majority of the jobs in social care, as my noble friend says, are in the independent sector and the Department of Health and Social Care does not have the levers to ensure a development pipeline. However, this is a challenge for us to meet, not something to turn away from: it is a matter of working across the whole of the workforce, no matter where they are from.

On professionalisation, I agree that we need to enhance skills, because care needs to be of the right quality. I mentioned earlier the development of the care workforce pathway, which is a new career structure, and also that the level 2 adult social care certificate qualification has been confirmed.

[Lord Evans of Rainow (Con)]

My Lords, will the long-term workforce plan include the voluntary sector and the army of unpaid carers, such as family, friends and neighbours—in other words, care in the community rather than in care homes?

[Baroness Merron (Lab)]

The workforce plan will be about employed members of staff. On unpaid carers, I am glad to remind your Lordships’ House that, from April, we will be increasing the carer’s allowance weekly earnings limit from £151 to £196, which is the largest increase in the earnings limit since the carer’s allowance was introduced in 1976. I hope that gives some indication of the mode of direction of this Government in respect of unpaid carers.

[Lord Palmer of Childs Hill (LD)]

My Lords, was the Minister listening to the answers to the previous question on the problems with the charity sector? Does she believe that the restrictions on revenue in the charity sector will have an effect on her department as well?

[Baroness Merron (Lab)]

I was indeed listening very closely to the questions put to my noble friend, and have been asked them myself on a number of occasions in this House. On national insurance contributions, the Chancellor did take that into account when deciding the funding for the Department of Health and Social Care, and made available up to £3.7 billion of additional funding for social care authorities in 2025-26. In addition to other further uplifts, I want to identify the £86 million uplift in disabled facility grants that will promote independence and allow some 7,800 adaptations to be made to homes in the very near future.

NHS: Single-sex Provision for Staff and Patients

Baroness Merron Excerpts

Wednesday 8th January 2025 Lords Chamber

[Baroness Fox of Buckley]

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

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

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

[Baroness Fox of Buckley (Non-Afl)]

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

[Baroness Fox of Buckley (Non-Afl)]

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

[Baroness Merron (Lab)]

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

--- Later in debate ---

[Baroness Thornton (Lab)]

My Lords, would the Minister agree that once again we must reinforce the need to treat everyone with compassion, dignity and respect, especially in media reports that discuss protected characteristics and cases of alleged discrimination?

[Baroness Merron (Lab)]

I would indeed agree with the comments of my noble friend.

[Baroness Hunt of Bethnal Green (CB)]

My Lords, is the Minister considering any possible unintended consequences of this guidance? As a lesbian who is frequently told she is in the wrong toilets and who is addressed as “my Lord” and “sir” frequently around this place—which is always cute—does the Minister think there might be some unintended consequences for those who are not trans but perhaps do not fit the immediate, on-first-glance version of what a woman might look like? Perhaps we should let women determine their own sense of identity in these situations.

[Baroness Merron (Lab)]

I am sorry to hear of the noble Baroness’s experience, which I have heard her speak of before. To me, as I said earlier, it points to the need to treat people with respect, with dignity and without making assumptions. I cannot emphasise enough the need for sensitivity and respect, which applies to everybody.

While we are talking about changing facilities, we should think about the huge difference in shops over the years. There used to be communal changing rooms, but you would be hard pushed to find them now. People have private spaces for changing and this again applies to everybody. I recognise the challenge of the NHS estate, of course, but I am talking about creative solutions and working with staff to get to where we need to be.

[Lord Kamall (Con)]

My Lords, the noble Baroness is absolutely right to talk about dealing with this issue very sensitively, by respecting people’s dignity and acting with compassion. However, some NHS staff and patients—the noble Baroness, Lady Fox, referred to this—have asked for single-sex provisions to protect their privacy and dignity. If the Government are planning further guidance, how do they intend to achieve that difficult trade-off and balance in potential conflicts between single-sex provisions for NHS staff and patients and the rights of individuals under the Equality Act 2010, while respecting their dignity and acting with compassion?

[Baroness Merron (Lab)]

The noble Lord raises an interesting point. In all cases with guidance, that is always the balance we seek to reach. I am also interested in the history of this, and I am sure the noble Lord will remember that the 2019 guidance on trans patients in single-sex spaces proved somewhat controversial, if I might put it that way. The guidance was meant to be updated under the last Government, but this did not happen. I am advised that it was delayed by a dispute between the previous Government and NHS England, which also delayed proposed updates to the NHS constitution. These again were consulted on under the last Government—which was a good thing—but nothing actually happened. So all these come to us as a new Government and will be given full consideration to get us into the right place.

[Baroness Burt of Solihull (LD)]

In the last few weeks alone, we have heard about the range of challenges facing our NHS: physically collapsing hospitals, extensive waiting lists and a social care review, to name but a few. More guidance in areas of uncertainty is to be encouraged. However, given that only 0.55% of the English population is trans, where does the Minister think that this should come in the order of priorities?

[Baroness Merron (Lab)]

I know that everybody in your Lordships’ House will take the view that the NHS is there both as an employer—as all employers are; this is not specific to the NHS—and in its service to patients. It is there to treat all with the right dignity and respect. We have a legislative framework to which reference can always be made. We will see what further guidance is needed—and that may be to all employers, not just the NHS. Again, I cannot emphasise enough the need for careful consideration and the involvement of all staff, on what has to be a trust-wide basis, because everybody is different in terms of their estate and what their challenges may be. It is not as simple as numbers: it is about fairness and dignity for all.

[Baroness Hayter of Kentish Town (Lab)]

My Lords—

--- Later in debate ---

[Baroness Hayter of Kentish Town (Lab)]

NHS England wrote to me to confirm that any patient can choose the sex of a chaperone. Will the new guidance define what is meant by “sex” in that case?

[Baroness Merron (Lab)]

There is, of course, already a definition in legislation of what that means. I know my noble friend will understand that I cannot predict what the guidance will be, but I will certainly pick up the point she has made.

[Lord Cashman (Non-Afl)]

My Lords, I remind your Lordships that I sit as a non-affiliated Member of this House. I encourage the Minister and the department to proceed with the utmost caution. Trans women and trans men pose a threat to no one. In relation to single- sex space, this House has debated the issue frequently. Therefore, does the Minister agree that the Equality Act works, with any measures for exclusion being on a case-by-case basis, proportionate and evidence-based? Will the Minister give the House an assurance that the Government will continue that sensible and humane approach?

[Baroness Merron (Lab)]

I agree with the noble Lord that the legislation provides a clear framework to all employers, but I also accept that some employers may wish to have further guidance on the existing legislation to enable them to make the right local decisions as employers, and it is that that we will consider.

Health: Obesity

Baroness Merron Excerpts

Tuesday 7th January 2025 Lords Chamber

[Baroness Boycott]

To ask His Majesty’s Government what assessment they have made of the obstacles presented by industry to delivering policies to prevent obesity, and what steps they plan to avoid such obstacles.

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

My Lords, we will make the shift from sickness to prevention to tackle the obesity crisis, working with industry where necessary and finding the most effective approach between mandatory and voluntary action. Since July, we have implemented our manifesto commitment to limit advertising of junk food to children, uprated the soft drinks industry levy and given councils clearer powers to block fast food outlets near schools, and we will continue this momentum.

[Baroness Boycott (CB)]

My Lords, I thank the Minister for that reply, and it is great to hear the steps that the Government are taking, but when we held our recent inquiry into ultra-processed food, we found a considerable conflict of interest. Although this is a legal and declared conflict of interest, it happens between the scientists advising the Government on food policy and the food industry. As we and, indeed, The BMJ magazine, revealed, the majority of the members of the Scientific Advisory Committee on Nutrition are either directly or indirectly in receipt of food industry money. Given that obesity rates continue to rise and, on the whole, government policies have either failed or been abandoned—there have been over 700 of them—do the Government think it is now time to insist that bodies such as SACN have no declared or otherwise financial links to food companies, which, after all, are the only ones to profit from the obesity epidemic?

[Baroness Merron (Lab)]

The noble Baroness refers to the report of the Food, Diet and Obesity Committee. I am grateful to her and the noble Baroness, Lady Walmsley, for chairing that committee and for the report. We are looking forward to responding by the end of this month. On the very specific question, I will look into the matter that she raised. I emphasise that our work with industry is to seek the most effective way forward between mandatory and voluntary action. What matters to us is successful outcomes in tackling what we regard to be an obesity crisis in this country.

[Lord Rennard (LD)]

My Lords, does the Minister agree that one of the major problems with tackling obesity in the UK is that we are second only to the United States in our consumption of ultra-processed foods? While the steps she announced are welcome, do we not need further measures, such as providing free, healthy, nutritious school meals as an alternative to the unhealthy fast food shops close to many schools?

[Baroness Merron (Lab)]

I certainly agree with the noble Lord about the need for favourable alternatives, and to educate people, particularly at a young age, about what healthy eating can look like, but it is also important to create the right environment and circumstances, and not everybody has that to hand. The provision of free school meals in the way the noble Lord referred to is of course a matter for local government to decide. I can say that the Scientific Advisory Committee on Nutrition has reviewed the evidence about ultra-processed foods and believes that further research is needed, which we have commissioned. Importantly, the committee has added UPFs to its watching brief and many are covered by existing legislation, because there are regulations on foods high in fat, salt and sugar which are applicable to ultra-processed foods.

[Lord Patel (CB)]

My Lords, I am delighted to hear the Minister say that the department has commissioned some more research. The small amount of research that is available suggests that processed, and particularly ultra-processed, food causes addiction, stimulating some dopamine centres, and that people who consume ultra-processed food want more food. In a small study of two groups of people, one consuming ultra-processed food and the other not, it was found that far more calories were consumed by those eating ultra-processed food. I would be glad to hear what research the department has commissioned to address this issue.

[Baroness Merron (Lab)]

The noble Lord raises a very interesting point. It is certainly the case that those who consume ultra-processed food have around 50% of their calorific intake through that matter. Where there is not clarity is on whether the foods are unhealthy due to processing or to their nutritional content. On that, the jury is out. We need to establish that. That is the why the Government’s Scientific Advisory Committee on Nutrition has concluded that the association between UPFs and health is concerning. We need to get to the bottom of why that is.

[Lord Kamall (Con)]

My Lords, the Minister rightly talked about the importance of creating the right environment for people to eat healthily. Some noble Lords may have seen daytime television programmes that help families to eat healthily on a budget. The challenge has always been how we take these lessons into people’s homes. I recently spoke to BRITE Box, a local community charity which gives families the ingredients and a recipe card with instructions to help them to cook healthy meals together. This helps with not only budgeting but addressing obesity. Rather than a top-down approach from the Government, what steps are they and the NHS taking to work with existing projects such as BRITE Box to take a bottom-up, community-led approach to tackling obesity?

--- Later in debate ---

[Baroness Merron (Lab)]

I thank the noble Lord and commend the organisation that he refers to—there are a number which are working very hard on this. We take a great interest in and seek to learn from such groups. This is a matter not just for the Department for Health and Social Care; it crosses government. We collaborate across government, particularly in pursuit of our health mission.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, does the Minister agree that alcohol is a substantial contributor to obesity and a range of related diseases? Is she aware that, notwithstanding promises given, the previous Government did not force the drinks industry to show calorific effects of their products on labels and consistently opposed doing it? Would our new Government be prepared to look at that and introduce such changes?

[Baroness Merron (Lab)]

I thank my noble friend for raising that point. We are in the process of reviewing the evidence on front-of-pack nutrition labelling, which can include bottles as well as foods. We will consider whether any further action is needed to support healthier choices.

[Baroness Jenkin of Kennington (Con)]

My Lords, I was a member of the Select Committee and I remind the Minister that the industry was reluctant to come and give us evidence. However, in the evidence that we took from young campaigners—the average UPF intake of some young people is 80% of their diet—they told us that they are overwhelmed with targeted advertising on social media, both from the food industry, particularly the UPF and HFSS industry, and local food chains. Do the Government have any plans to reduce that or encourage the industry to bombard them less on social media?

[Baroness Merron (Lab)]

I accept the noble Baroness’s point about the influences on young people, in particular. It is exactly why, in December, we laid secondary legislation to implement a 9 pm TV watershed for the advertising of less healthy food. The noble Baroness referred to social media, and we are looking into that to see what may be necessary, but I accept the link she made.

[Lord Bird (CB)]

My Lords, nowhere do I see a declaration by this Government or the former Government that up to 50% of people who present themselves to our A&E and medical services are suffering from food poverty. If we threw that around more often, we might decide to do something significant about the role of poverty.

--- Later in debate ---

[Lord Bird (CB)]

My question is: when are we going to get rid of poverty?

[Baroness Merron (Lab)]

As soon as possible.

[Lord Beamish (Lab)]

My Lords, the Mental Health Foundation produced an excellent report on body image, which is about how not just younger people are affected by it but an increasing number of older people as well. It leads to people undertaking cosmetic surgery, some of whom go abroad because it is billed as being cheaper. What is the Minister doing to track this surgical tourism? What is the cost to the NHS?

[Baroness Merron (Lab)]

My noble friend is right that there is certainly an increased cost to the NHS. I do not have the exact figures available, but I would be pleased to look into it. We are very mindful of this and advise in particular that people should not go to areas where healthcare services are not properly regulated. They do so at their own risk, and it often comes back to the NHS to put that right. This is an increasing problem and one we are seeking to tackle.

Health and Adult Social Care Reform

Baroness Merron Excerpts

Tuesday 7th January 2025 Lords Chamber

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

I thank both Front Benches for their welcomes, in varying degrees and to varying aspects, for the two plans: one to deal with social care into the very far future—something that I would want to emphasise—and the other on electives. I, too, pay tribute to NHS and social care staff, not just for the work that they did through Christmas and the new year but for the work they do and the commitment they show in some very difficult circumstances all year round. That is exactly why we have come to your Lordships’ House and the other place with this Statement.

To start with social care, the noble Lord, Lord Kamall, talked about the agreement that was around in respect of the social care cap, but that really dealt with only one aspect of social care; what we seek to do is something that actually has not happened before, which is a very comprehensive and long-lasting approach that will transcend politics and last, no matter who the Government are, and that is perhaps what has been lacking. Certainly, I would agree that there has been no shortage of ideas in the past 15 years—some good and some, as I am sure some people would say, less good—but what there has been a lack in is a different way of doing things and a different approach, and that is what the independent review led by the noble Baroness, Lady Casey, will seek to provide.

I am glad that both opposition parties have accepted the challenge or invitation from the Secretary of State to participate in a cross-party solution, and I am most grateful to party leaders and spokespersons for that. I want to put on record that the noble Baroness, Lady Casey, is regarded as Whitehall’s number one doer; she is a leading social reformer, and she has served Governments of all political stripes, which equips her very well to talk about building a national care service.

I understand the concerns raised about the amount of time that is being taken. The noble Lord, Lord Scriven, referred to that. Perhaps I can reassure your Lordships’ House that the first report will be published next year, with recommendations that can be implemented as soon as possible. The final report will be later in the Parliament.

I should also say that we have not actually waited. It is important to say that there are a number of things happening right now, because I do not want your Lordships’ House to believe that everything is waiting for the conclusion of the report. I shall run through some of them because I think they are helpful in terms of social care. Legislation has happened for the first ever fair-pay agreement, which will tackle the 131,000 vacancies that social care is currently carrying and is a real problem in providing service. On the budget, I was very glad that your Lordships’ House welcomed the biggest increase in carer’s allowance since the 1970s. There has been an extra £3.7 billion for local authorities and, last week, the immediate release of £86 million for the disabled facilities grant, which will enable some 7,800 home adaptations before April. There has been a whole range of reforms, including the current introduction of new standards.

The noble Lord, Lord Kamall, asked about digitisation. Joining together medical and care records is so important. I know from the report of the House of Lords committee chaired by my noble friend Lady Pitkeathley that the most concerning aspect for those who care for those who need that support is that they constantly have to say what is wrong and what the issues are. Always having to repeat things was the number one issue that that report identified. We are also training care workers to perform more health interventions. I would say that there has been a lot done but that there is an awful lot more to do, which is why I am very glad about this approach. I do not regard this, by the way, as kicking the can down the road; I regard this as realistic for the situation that we are now in. I must emphasise that we really want a cross-government approach that will outlast any Government, no matter who they are, into the future.

On electives, the noble Lord, Lord Scriven, asked about measuring outcomes and ensuring that, in meeting one target, other matters are not overlooked. He makes an extremely fair point, and we will, as part of the ongoing work, look at how we measure and how we avoid the unintended consequences that both noble Lords have referred to. I am grateful for the reminder on that point. It is important, and noble Lords will have heard it said by the Secretary of State, that we take the best to the rest—I think that is crucial. There is some excellent work that goes on across the country, but it is not universal or serving everybody.

On reducing waiting times, the noble Lord, Lord Scriven, used the word ecosystem, which I would absolutely share. For example, the failure of social care currently puts enormous pressure on the NHS. It is an ecosystem, and not always a positive one, I might add. If we go back to November, some 12,400 people every day were well enough to leave hospital but could not do so because it was not possible to discharge them. That is a failure of social care very much linked to the NHS, but we also have an ageing society. By 2050, we will have 4 million more people aged 65 and over than we have now and if we do nothing, for example, on social care, the costs will double over the next two decades. Neither exists in isolation. Social care and the NHS come together.

I say to the noble Lord, Lord Kamall, that this is absolutely a cross-government problem which will require a cross-government solution. Of course, it will be very much part of the 10-year plan and part of our three immediate pillars of change, which are sickness to prevention, hospital to community and analogue to digital.

This is about major reform, not kicking the can down the road on social care and the NHS. I know the noble Lord was not suggesting that of the NHS. On workforce, we are currently making plans which are different from those of the last Government, so we must carefully look at not just numbers but the range of skills and professions needed. This reform requires change. It is not about standing still.

The noble Lord, Lord Kamall, asked how we will keep centres open for more hours. It was one of our manifesto commitments, and we have held many discussions with workforce representatives to seek a wide range of solutions. One proposal, which has been extremely well received, is to offer to pay people overtime to do the work. We are already reducing waiting lists through this. We all know that the current working hours of the NHS do not reflect the reality of people’s lives.

This is a really big opportunity to make a major change and grasp the many nettles. I wish all of it could happen immediately—particularly on social care, as we know that it has taken a long time and many have failed along the way—but it will take time. However, we have the plan and a commitment to support, guide and resource not just the NHS that we need now, but that we will need in the many years ahead.

[Lord Laming (CB)]

My Lords, the Statement is most welcome, not least the attention given to social care services. I congratulate the Minister and the Government on striking that proper balance between health and social care. The issues are hugely challenging, very expensive and important for the whole of society, especially if the National Health Service is to survive and prosper, for reasons that the Minister has touched on. The issues in social care range from recognition of the very important contribution of unpaid carers to the fact that a large number of local authorities face financial problems which place their future in a degree of jeopardy. The commission to be chaired by the noble Baroness, Lady Casey, will tackle these and many other issues, but we have to get through the immediate situation. Can the Minister assure the House that, in taking the social care agenda forward, from today these matters will be kept in sharp focus and handled with great vigour and determination?

[Baroness Merron (Lab)]

I am pleased to give that assurance and thank the noble Lord for his welcome for these measures. As I mentioned earlier in response to opposition Front-Benchers, we have not waited. In the last six months, we have made a number of immediate changes. He mentioned carers, and it is worth emphasising that, as I said, the increase in carer’s allowance is the largest since the 1970s. It will mean roughly an extra £2,300 a year for family carers. That is extremely significant. This House rightly presses me on the need to recognise carers, in particular unpaid carers, which we have done. The whole range of measures I described earlier will show our direction. I look forward to the noble Baroness, Lady Casey, publishing her first report next year. Those recommendations will also be there straightaway. We are doing this on all timescales.

[Baroness Pitkeathley (Lab)]

My Lords, it is indeed gratifying, as the Minister has mentioned, that many of the health proposals take into account the report of the Committee of your Lordships’ House on integrated care, which I had the privilege of chairing. I am going to take it for granted that the issue of unpaid carers will be the focus of the commission’s report, since the whole edifice of social care depends on unpaid carers.

Does the Minister agree that social care and health care work best when you cannot see the join between them? Therefore, are we able to look at employing people across both disciplines—and indeed across the voluntary sector as well, which provides many of these workers—in order that the focus can be on the patient or the user, and not on the institution?

[Baroness Merron (Lab)]

As the House knows, my noble friend is a great campaigner on this issue. I can certainly assure her that the review will include exploring the needs of the 4.7 million unpaid carers who effectively hold the adult social care system together. On the point about the care workforce, we are already improving career pathways by expanding the national career structure, including new role categories. The suggestions my noble friend makes about a seamless service are quite right. We are a long way from that, but I hope we will be able to get to it, and the workforce will be key in that.

[Lord Lansley (Con)]

My Lords, may I tell the Minister that the Statement is not an accurate representation of what happened in 2009-10? More importantly, it is now over 13 years since Andrew Dilnot produced his report, and there have been many promises to implement it that have not been kept. There should be no further delay. The Minister should acknowledge that if there is further delay in implementing a social care cap on costs, many thousands more people will face the catastrophic loss of their life savings and earnings as a consequence of meeting those costs. Until we implement the cap on social care costs, we will not know whether it will deliver a market in providing insurance against long-term care costs, which in itself would make a significant contribution towards meeting some of the costs of social care in the future.

[Baroness Merron (Lab)]

I understand the wish of many, myself included, for more urgent action. However, the reality is that acting in haste will not solve the problem, not least because of the depth of the difficulties we are looking at. The noble Lord is right that many promises have been made—a number by his own Government—but not fulfilled regarding what should happen on the cap. I reiterate the point I made earlier: while I appreciate that there are Members of your Lordships’ House who believe that Dilnot is the answer, it deals with just one aspect, and that is not what we need. As my noble friend just said, we need a comprehensive look at creating a more joined-up service that will work around people, rather than focusing on institutions or one particular problem.

[The Lord Bishop of St Albans]

My Lords, I am grateful to His Majesty’s Government for trying to get cross-party agreement on this really important issue; it is important that it does not get lost in party politics. It is good to hear about the improvements to the NHS app, which is working quite well in some areas already. However, some people are digitally excluded, and there is a lack of connectivity in rural areas. How are we going to ensure that these groups are not excluded as we go forward with this important work?

[Baroness Merron (Lab)]

The right reverend Prelate is correct to mention—I have raised it myself—not just the digital exclusion of individuals but connectivity. It is one of the reasons that we will approach this in a cross-government fashion. However, on our move from analogue to digital—the noble Lord, Lord Kamall, rightly mentioned the capacity of the NHS—our view is that it can do so much more than it is doing currently. The Secretary of State said in the other place that restaurants, for example, have been texting customers for many years, have they not? They remind customers about their booking and give them a chance to cancel or change it. That is the kind of connectivity and service that we need from the NHS. I assure the right reverend Prelate that, where people are unable to use whatever the digital solution might be, they will be able to deal with it person-to-person or on paper. We will be flexible enough and actively seek out those who are not, as he described, immediately connected.

[Baroness Tyler of Enfield (LD)]

My Lords, the Darzi review estimated the impact of delayed discharges at some 13% of total hospital beds. Given this, can the Minister say how confident she is that the immediate steps to improve the rate of discharge from hospital into social care, which she has already outlined, will happen? How quickly will that happen and over what timescale, and what accountability measures will be established at both national and local levels to ensure that those delayed discharges start to come down, and quickly?

[Baroness Merron (Lab)]

The independent review by the noble Baroness, Lady Casey—in addition, as I mentioned, to producing recommendations that can be implemented straight away next year—is focusing on completing its final report later in this Parliament, so we are looking at the longer term. I cannot give an exact timetable, although I am hopeful that we will be able to update your Lordships’ House with further information, as the noble Baroness quite rightly asked. The matter of discharge requires there being suitable facilities in the community, but we are not in that place, so this will take some time. But I am very hopeful that all of the measures here, and the measures we have taken already, take us further to that point. We will continue to strive on the matter of discharge, because it is a problem not only for the NHS but for patients and their carers and for social care. We are carrying, as we know, a lot of vacancies and a social care system that is creaking at the seams: we must be honest about that.

[Lord Patel (CB)]

My Lords, I welcome the Statement and many of the proposals in it. We have learned from past experience that all reforms to, and any proposal to change things in, the NHS—and, for that matter, social care, but more so with the NHS—lead to increased bureaucracy but not the benefits that we thought they might deliver. One of the waiting list initiatives is that GPs will have a consultation with hospital staff to try to reduce waiting times and avoid unnecessary duplication. There is some financial incentive attached to that, but it certainly will increase bureaucracy. What modelling has been done to find out whether it will work, whether it will increase bureaucracy and by how much it will increase costs?

[Baroness Merron (Lab)]

I am grateful to the noble Lord for welcoming many of the measures in this announcement. He referred to the £20 fee that will be paid to GPs to call the consultant where necessary. I understand the concern about increasing bureaucracy, but all these reforms are intended to work the other way. We will very closely monitor them and have very carefully considered them with all those who will be dealing with them. I am actually more than hopeful, because the intention is that allowing the GP, for example, to get further advice, and making sure that people are being seen in the right place, will save money. It will mean that people are not taking up a referral place and that they will be referred for the necessary tests, scans, et cetera without the middle bit, which is a very backward-facing way of dealing with things. We will continue to monitor that to ensure that we are reducing what is currently wasted clinical time, while also preventing unnecessary out-patient appointments. The monitoring should show all of that and I will be very happy to update the House on that. The fee is to ensure that it can happen and is an incentive to do so. Of course, the greatest prize is an increased and speedier service for patients.

[Lord Turnberg (Lab)]

My Lords, it is pleasing to welcome the proposals from the Government. It is also very pleasing to hear of the immediate things that can be done for social care, because we should not be waiting for the final report.

There are some more suggestions that we could make that do not require any money—that should be music to the Minister’s ear. We do not need more money to reduce the bureaucracy that people in the community are required to go through to gain admission to a care home. It is horrendous. They have a means test and a needs test serially, which can be very bureaucratic and time-consuming, and there are waiting lists. We must reduce that bureaucracy.

The second thing, which the Minister has already referred to, is the value that we place on care home workers. It is good to hear that they will get a rise in their money and that ideas will be put about on their careers, but, unless they have a recognised national qualification and registration of that qualification, career prospects will be limited. We must do more for them to allow them to see themselves in a career that could go on to nursing in the NHS. We must do more in that field if we are to retain these enormously valuable people.

[Baroness Merron (Lab)]

My noble friend, as always, makes very practical observations. I totally agree with the point about bureaucracy in terms of care homes. I have experienced that as I have power of attorney for an elderly friend, and I constantly wonder: if I am struggling with it, what would it be like for somebody who perhaps is not as used as I am to dealing with forms, organisations and, indeed, bureaucracy? It is extremely troubling. Yes, that will be part of what we will be looking at to improve social care—and also the discharge ability that we were talking about earlier. Valuing care workers, professionalising the service and recognising them are all key. I agree that it should be a natural move from being a care worker into a clinical setting, but we also need to recruit people to be care workers, retain them and upskill them, which is so important.

[Lord Bellingham (Con)]

My Lords, on the vexed subject of delayed discharge of very elderly patients who have been admitted from care homes, quite often with ailments such as flu, medicine management, wound-dressing management, et cetera, surely the key is to ensure that many of these patients are not admitted in the first place. This follows on from the last question about the training of care workers. Is there an argument for enhancing their training so they become better carers in terms of dealing with these problems? Can the Minister say something about what I know has been tried in a number of care homes: having intermediate NHS beds in care homes?

[Baroness Merron (Lab)]

Both the points that the noble Lord makes are very welcome and shine a light on the need to be more flexible in the range of services and care provided. It should not be just an either/or. People have intermediate stages. Some of the issues about discharge are about having a position in the middle, which is more about rehabilitation, and having the things in place to allow people perhaps to return home or to some other setting.

There is also the point about having a range of settings. Currently, the offer is perhaps too restrictive, although not in all places, as there are some excellent examples. We must be much more creative in the kind of offer that is available and in the training of care workers, not just for the service that they offer to patients, which is important, but for their professionalisation and their morale in their jobs.

[Baroness Hollins (CB)]

My Lords, why is there no mention of mental health in the Statement? What happened to parity, I wonder? For example, 12,400 hospital patients a day are well enough to be discharged. I presume that this does not include the 1,500 or so autistic people and people with learning disabilities who are waiting to be discharged from psychiatric hospitals but for whom there is no social care? Community diagnostic centres are mentioned but there is nothing about the need for 24-hour community drop-in centres for citizens who have mental health problems. Social care costs for elderly people may be expected to double, but what about the increasing costs of care for disabled adults of working age?

[Baroness Merron (Lab)]

The noble Baroness makes very real and important points. Some of the points in the Statement cover mental and physical health but, if I might be honest about the situation, this is only one of the things that we are putting forward. As I said at the beginning of this Statement, how I wish that we could deal with everything immediately. It is not possible. This is just the first stage in the journey that we are on. I hope that the noble Baroness is reassured by the direction that we are taking, the commitments and the work that we have already done on mental health. The Committee stage of the Mental Health Bill next week will also be a very significant step forward. I absolutely accept that there is so much more to do, and we will be getting through that.

Hospice Funding

Baroness Merron Excerpts

Monday 6th January 2025 Lords Chamber

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

I thank the noble Lord for his good wishes and extend my new year wishes to everybody in your Lordships’ House.

To clarify the situation, this is the biggest boost for hospice funding in a generation. It is £100 million in capital, and there is no intention, as the noble Lord asked, to have any less engagement with the third sector—in this case, the hospice sector. The £100 million in capital is for adult and children’s hospices, and £26 million is confirmed for children and young people’s hospices. This has been widely welcomed. The decision in respect of national insurance perhaps would not have had to be made had the financial situation inherited by this Government been somewhat different.

[Baroness Brinton (LD)]

My Lords, I am grateful to the noble Baroness for explaining about the capital grant, but can she get the Government to commit to a long-term revenue funding formula for hospices for those services that are equivalent to those provided in the NHS, so that they are rewarded financially on the same basis as the NHS fairer funding formula?

[Baroness Merron (Lab)]

I understand the point the noble Baroness is making, because planning ahead and certainty are key. I can confirm that my ministerial colleague, Minister Kinnock, will soon meet all major stakeholders to discuss long-term sustainability of funding. We are very aware of the difficulties that have been caused thus far and seeking a way forward.

[Lord Forsyth of Drumlean (Con)]

My Lords, I commend to the Minister a scheme that I introduced when I was Secretary of State for Scotland, at the suggestion of the broadcaster Martyn Lewis, who wrote a book on the hospice movement in tribute to Dame Cicely Saunders. That scheme introduced pound-for-pound funding: every pound raised was matched by the Government, which had the effect of greatly increasing funding and the incentive for people to support the hospice movement. Will she consider introducing such a scheme, which, alas, did not survive the introduction of the Scottish Parliament?

[Baroness Merron (Lab)]

The noble Lord makes a very interesting point. Of course, the introduction of gift aid supported charitable funding, including to hospices, and I know was very warmly welcomed. These are all important ways of looking at funding and we will consider the best way forward, but I note from discussions with the hospice movement that hospices very much value their autonomy in terms of funding; the more linked it is to government funding, the less autonomy they have. We want dignified and appropriate care for patients and families, and to find the best way to deliver that.

[Baroness Finlay of Llandaff (CB)]

My Lords, I pay tribute to Lady Randerson, who was a great supporter of hospice and palliative care services in Wales, as well as a dear friend. I declare that I am vice-president of Hospice UK and have been involved in setting up the palliative care commission, which will be chaired by Professor Sir Mike Richards and will start to take evidence this week. Can the Minister inform us of the department’s work to look at different funding formulae, such as the one we developed in Wales, which respects the individual autonomy of the voluntary sector while ensuring that some of the black holes of provision can be filled? Will the Government collaborate with the commission by providing as much evidence as possible so that Professor Sir Mike can come up with some really firm recommendations for the future?

[Baroness Merron (Lab)]

I associate myself with the tributes paid to the great contribution that the late Lady Randerson made to this House. She will be sorely missed. In addition to Minister Kinnock meeting major stakeholders, including Macmillan, Together for Short Lives and a number of other organisations and charities to discuss sustainability of funding, Ministers will continue to have discussions with NHS England, because the other area is about getting the money promptly, which has not happened to date. Again, that has caused huge difficulties. We very much look forward to seeing the commission’s findings and recommendations and will look at how we can work to support it.

[Lord Scriven (LD)]

My Lords, I add my tributes to Lady Randerson and wish the Minister a happy new year. As welcome as the £100 million in capital is, it will not pay for staff, drugs, heating, lighting, meals or day-to-day services. What are the Minister and the Government going to do to add extra revenue funding to deal with the costs that the hospices are dealing with now?

[Baroness Merron (Lab)]

As I mentioned, it has been confirmed that there will be funding for children and young people’s hospices for the forthcoming year, which I know had been hoped for but not actually delivered. I am very glad that the Secretary of State was able to confirm that. On long-term sustainability, Minister Kinnock is very much looking forward to meeting major stakeholders and is working with NHS England to find the best funding mechanism, in respect of the £100 million capital grant and more generally.

[Baroness Winterton of Doncaster (Lab)]

My Lords, it is very good news that the commission is in the safe hands of Sir Mike Richards, who I worked very closely with when I was a Health Minister. Could my noble friend set out the ways in which the Government might assist the hospice sector with training, because there must be a crossover in the different tasks undertaken? In particular, could some of the changes announced for social care workers be transferred to the hospice movement?

[Baroness Merron (Lab)]

My noble friend makes a very helpful point that I will certainly follow up. The fact that the majority of hospice care is provided through the NHS suggests that there is room for further co-operation between the independent hospice sector and the NHS. I am grateful for her comments and will follow that up.

[Lord Balfe (Con)]

My Lords, I remind the House that I am joint chair of Together for Short Lives, the hospice movement for babies and young persons. We greatly welcome the decision and announcement by the Government. Our only hope, as has been alluded to, is that there will be a development to get some forward perspective. One of the problems I addressed in my meeting with Minister Kinnock was the short-termism there has been. Can we use this gap to try to get a longer-term perspective for funding?

[Baroness Merron (Lab)]

We would certainly like to do that. As I mentioned, we will talk with Together for Short Lives and others to achieve that. It is very important to make sure that there are no delays to funding and that it promptly gets to where it needs to be. That is the other area we will attend to.

Puberty-suppressing Hormones

Baroness Merron Excerpts

Monday 16th December 2024 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, on these Benches we welcome the tone of the Secretary of State’s Statement. I have often said that there are many ways of being human. Growing up can often be a very trying time for teenagers. How much more difficult, then, for those young people with gender distress who are struggling with finding out who they are while being different from their peers, and all without adequate support? It is high time that proper services were put in place for young people struggling alone with these issues. Their families too need help to support them at this difficult time. For too long, children and young people who are struggling with their gender identity have been badly let down by a low standard of care, exceptionally long waiting lists, even by the standard of mental health waiting lists, and an increasingly toxic debate.

We always want to see policy based on the evidence. With any medical treatment, especially for children and young people, the most important thing is to follow the evidence on safety and effectiveness. It is crucial that these sorts of decisions are made by expert clinicians, based on the best possible evidence. It is also important that the results of the consultation and the advice of the Commission on Human Medicines are made public.

Some might wonder why the treatment is deemed not safe for gender dysphoria patients but safe enough for children with early-onset puberty. More transparency might clear up the confusion and give more confidence to patients and their families. However, the Secretary of State himself admits that he does not know what effect the sudden withdrawal of this treatment for young people already embarked on a course of puberty blockers will have. These are the young people with the most urgent need for other types of care in the current situation, so what clinical advice have the Government taken about the effect of withdrawing these drugs on the physical and mental state of young sufferers of gender incongruence already on the drugs, and what physical and psychological support will be offered to them?

In the current circumstances, plans for a clinical trial are welcome, but we would like to know the criteria for those eligible to participate. What assessment have the Government made of the recent Council of Europe report, which raises the ethical and rights implications of offering participation in the trial to only a small group of patients? If the only way to continue access to these drugs is through participation in the clinical trial, whose scope, length and start date have yet to be announced, this lays the Government open to accusations of coercion and breaches of human rights.

We welcome the plans for additional treatment centres in Manchester and Bristol as well as London, but can the Minister say why they will not be up and running for two years? Is it lack of funding, lack of premises or lack of sufficient therapists with the appropriate specialist training? This is a very sensitive area, so the wrong people could do more harm than good. If that is the reason, is there a plan for training up more qualified therapists in time for the opening of the regional treatment centres? I very much look forward to the Minister’s replies to these questions.

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

My Lords, I start by thanking the noble Baroness, Lady Cass, for her work in this very important area. I also refer to the actions taken by the previous Government, which set in train the action we are continuing. As both the noble Lord, Lord Kamall, and the noble Baroness, Lady Walmsley, rightly said, this is about keeping children safe. There is nothing more important than evidence-based action—which is what we have before us—and taking the necessary steps.

The Cass review made it clear that there is not enough evidence about the long-term effects of using puberty blockers to treat gender incongruence to know whether they are, first, safe and, secondly, beneficial. It is important to bear both in mind. The Commission on Human Medicines independently found that clear evidence of unsafe prescribing exists and recommended that there should be a ban until there can be a safe prescribing environment. That is where we start, and last week’s laying of legislation stops that unsafe prescribing to children and allows time to develop the necessary safeguards, as recommended by the commission. I should just clarify that the legislation is indefinite, not permanent. There will be a full review in 2027 so this continues to be a very live issue.

The clinical trials, referred to by both the noble Lord, Lord Kamall, and the noble Baroness, Lady Walmsley, will be a world first. It is important to pay tribute to that. In addition to the work currently being undertaken to respond to the recommendations of the Commission on Human Medicines, the trial is presently undergoing development and approvals. The aim is to begin recruitment early in the new year. I am sure there will be an opportunity to update the House on that detail.

In answer to the point from the noble Baroness, Lady Walmsley, the numbers will be uncapped, which is important. I am sure we all agree that better-quality evidence is critical. The development of the clinical trial between the National Institute for Health and Care Research and NHS England will provide the better-quality evidence that we are all looking for.

The noble Baroness, Lady Walmsley, spoke about new services. To make the situation clear, NHS England has already opened three new services in the north-west, London and Bristol. The fourth will be in the east of England and will open its doors in spring next year. The noble Baroness also asked about the timetable; we are on course to have a service in every region of England by 2026. I cannot always confirm developments of that nature, so I am glad to do so because it will help reduce the waiting list, which noble Lords are rightly concerned about. It will also bring services closer to home, which is crucial too.

Furthermore, this is a very specialist area, so recruitment and training are key. This is part of the reason for the—I would not call it a delay—realistic timetable. There is also the need to work with local trusts and take into account all the various operational considerations, so realism rather than delay is how I would put it to the noble Baroness.

I agree with the points made by noble Lords on the Front Bench about tone and discourse. I am very grateful to the noble Baroness, Lady Walmsley, and the noble Lord, Lord Kamall, for welcoming the way the Secretary of State made the announcement and what the announcement refers to. We have a real responsibility in this House—and outside it—to handle conversations on this topic extremely sensitively. This is about people’s lives. I absolutely agree with the point just made: the public debate has been frighteningly toxic. Irresponsible statements made recently have put young people at risk of serious harm and that has to stop. That is one of the many reasons I welcome the Statement—and the tone and discourse this evening.

On the point made by the noble Lord, Lord Kamall, about alternatives to puberty blockers, no exact alternatives are being offered. However, within the new services there will be an emphasis on, for example, psychosocial support.

In response to the point made by the noble Baroness, Lady Walmsley, about the—she did not use this word, but perhaps I might—transparency of evidence, all the commission’s recommendations have been published in full as part of the Government’s response to the consultation. The full advice, as I hope the noble Baroness will understand, was prepared solely for Ministers, but we are considering whether it should be published. I know the noble Baroness will understand that, as with all advice prepared for Ministers, there are legal and other matters that must be considered before it can happen.

I will say a word on mental health support, which is so important for children and young people. An offer of an appointment with a mental health professional has been made to everyone on the national waiting list for children and young people’s gender identity services. Those who joined the waiting list on or after 1 September will have an appointment with a mental health professional or paediatrician before being referred to specialist gender services. Those who are not on the waiting list and are directly affected by the restrictions can access NHS mental health services through a dedicated single point of contact, supported by clinical nursing.

I hope that is helpful, and if there are any points I have missed—

[Baroness Walmsley (LD)]

Can the Minister address the issue of the children who are part-way through a course of treatment? Will they get mental health support as a priority?

[Baroness Merron (Lab)]

For those who are already on puberty blockers, there is an immediate withdrawal. But I hope that what I have outlined on mental health support covers all the areas the noble Baroness, and indeed all of us, are concerned about. The approach is as compressive as possible, and the new gender services I described should make it even easier to provide the service. It is not a matter of waiting until 2026; we absolutely understand the need to provide that support now, and we are making that available.

[Baroness Cass (CB)]

My Lords, I echo the thanks given to the Secretary of State for his careful and scientific approach to this issue and for his very sensitive Statement in the other place.

It might be helpful to elaborate on just one or two of the points that have been raised, particularly the use of puberty blockers for precocious puberty—that is, for children who enter puberty too early—which is a licensed use of these drugs. We are confident about that use because we have many years of experience, and because it is a very different situation from prescribing for young people with gender dysphoria. The difference is that children with precocious puberty have an abnormal hormone environment, which we normalise, whereas in young people with gender dysphoria we are taking a normal surge in pubertal hormones and disrupting it. That is why it is much less clear what the long-term impact of that intervention is, and why we need careful clinical trials.

The second thing it would be helpful to clarify is the appropriate question, asked by the noble Baroness, Lady Walmsley, about children and young people who are already on puberty blockers from private or overseas sources. In addition to the comments made by the Minister, it is important to know that NHS England has set up a telephone number that young people and families can ring to receive a mental health triage. Young people’s mental health services have been forewarned and are on hand to provide that triage for that small group of young people who may be in significant distress because of fear of interruption of their supply of puberty blockers. There is provision that, in those circumstances, and where the clinician thinks it is in the best interests of that young person to continue on puberty blockers, an NHS prescriber is allowed to continue the prescription. We hope that those in distress will come forward and contact NHS England and therefore be supported through the system.

One of the other misunderstandings about puberty blockers is that they have become totemic as the main treatment or entry-point treatment for young people who want to transition, or who may in the longer term be trans but may not go on to a medical pathway. Young adults have said to us that they wish they had known when they were younger that there were more options for them than a binary medical transition, and that there were many more ways of being trans—that they could remain gender fluid, continue to be non-binary, or in the longer term continue to be a cis adult, as some do, and not go through any medical interventions at all.

Having a multidisciplinary team that can support young people in that decision-making without necessarily rushing them into a medical pathway is crucial, and that is what the new services have now embarked on doing.

[Baroness Merron (Lab)]

I thank the noble Baroness for bringing her expertise directly into the Chamber. We are very glad that she is in the House to do so, and she has actually answered a number of the points better than I ever could.

I will emphasise one point that I am particularly interested in, because I know it has been raised a lot, about why the legislation is being laid in respect of the use of medicines just for gender dysphoria. The noble Baroness, Lady Cass, referred to this. It is really important to emphasise that the medicine might be the same, but the fact is that it is not licensed for gender incongruence or dysphoria—that is the key point. These medicines have not undergone that process, which means that safety and risk implications have not yet been considered. It is true that there are licensed uses of the medicines for much younger children or for older adults, but the issue here is about adolescents, and it is an entirely different situation.

[Lord Winston (Lab)]

My Lords, perhaps I might return to the conventional asking of a question to the Minister—a very quick question. There are a number of practitioners who are considering, if not giving, sex steroids to patients who are requesting gender reassignment; either oestrogen or progesterone, or the equivalent male hormone. Have the Government yet considered how patients will be treated in this situation? There are certain, clear dangers involved.

[Baroness Merron (Lab)]

I understand the point my noble friend rightly raises, and I emphasise again that what matters here are safety considerations—particularly when we are talking about children and young people—but also the evidence in respect of treatments, that there should be the prescription only of medication which is safe and appropriate to the actual patient and situation.

[Baroness Jenkin of Kennington (Con)]

My Lords, given that puberty blockers almost invariably lead to cross-sex hormones, can the Minister explain why the proposed trial cannot study those who have already used or are using puberty blockers, rather than starting with a new cohort of children? Given that the trial will look at the long-term effects on health, does she have any indication of how long that trial will need to continue, and is it right that it might be for up to 30 years?

[Baroness Merron (Lab)]

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

[Baroness Fox of Buckley (Non-Afl)]

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

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

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

[Baroness Merron (Lab)]

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

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

[Baroness Morgan of Drefelin (Lab)]

My Lords, I too welcome the Statement. The tone, as we have already heard, has been absolutely right. Thinking about the clinical trial, I would like to know a little more about the timing. If we are intending to run a clinical trial that is going to be looking at efficacy and safety, it will not be an easy trial to run and it is going to take some time. It would be really welcome if the Minister could keep the House informed, which she has already promised to do.

I am particularly interested in hearing the Minister’s view on the following point. It is really important to get this clinical trial on the puberty blockers going, but we also need to understand the value and the evidence supporting all the other interventions too—the psychosocial support, the psychological support, and all the other interventions—so that it is not just this clinical trial but a broad understanding of what really helps these young people. `

[Baroness Merron (Lab)]

My noble friend is right to raise the second point. It is a whole range of interventions, and that is certainly something that we have very much in mind for consideration, for the reasons that we have heard in the Chamber this evening and the points that my noble friend makes. In respect of timings, it is a planned pathway study and that includes a clinical trial component. It is, as I said, to build evidence. I am glad to say that it remains on track to commence recruitment early in 2025, but only after there has been ethical approval. When that is granted, that is when the final study protocol will be ready, and I know that noble Lords will have a lot of interest in that. We will be issuing further updates in early 2025, and if there are any particular questions, noble Lords are very welcome to raise them with me.

[Baroness Bennett of Manor Castle (GP)]

My Lords, my question follows on from that of the noble Baroness, Lady Walmsley, about the scale of the trial. I also note the report from the experts at the Council of Europe, which the noble Baroness referenced. In the other place, the Secretary of State said in response to my honourable friend Carla Denyer that the clinical trial would be “uncapped”, and the Minister repeated that word this evening. However, an article published yesterday in the Metro, arising from various freedom of information requests and headlined, “Trans Youth ‘Languishing’ While Waiting Six Years For Gender Healthcare”, said:

“If a trans young person joined the waiting list for gender-affirming healthcare on the NHS today, they would have to wait 308 weeks for a first appointment”.


In that context, I am struggling to understand where the Government will secure the resources from to run a trial to provide the resources needed to have this uncapped clinical trial allowing access to puberty blockers.

[Baroness Merron (Lab)]

In view of what the noble Baroness said, it is quite important to consider that the children and young people’s gender services waiting list currently has 6,237 people on it. I certainly agree that waiting lists for these services are too long. We are committed to changing that, which is why I outlined the timetable for the new gender services and the opening of the new centres. They will increase clinical capacity and reduce waiting times for sure. On the point the noble Baroness raised, there is a commitment to the clinical trial, and I am glad there is. As we have brought forward this legislation in an absence of evidence, it is incumbent on us, as a Government, to follow through on what the previous Government started in train, which is to use a clinical trial to provide the evidence. Otherwise, the debate would remain uninformed and not evidence-based, and that cannot be helpful.

[Lord Jackson of Peterborough (Con)]

My Lords, I welcome the Statement and congratulate the Secretary of State on the moral clarity and leadership that he has shown in balancing the evidence base with compassion. Perhaps I may press the Minister on a few points. An indefinite ban is not the same as a permanent ban. Is there a chance that the indefinite ban, which goes to 2027, may segue into a permanent ban as more information and evidence arise over the next few years?

Given that it is pretty well understood that puberty blockers have given rise to fertility problems, bone health issues and psychological health issues, I cannot understand the inconsistent policy of keeping children currently on puberty blockers in the system, when we know that there is no positive evidence base and only a negative one. I think that will affect many children.

My final point is about the eight new regional centres that will be set up. Will we be certain that the ideologically-driven zealots—clinicians who misuse their position and have prescribed unsafe puberty blockers for children and young people—will not find themselves in these new facilities? That is an important issue as we wait for the clinical trial and ruminate on the issues that the noble Baroness, Lady Cass, mentioned. We need to start again on this and to understand that there are more treatments available for the most vulnerable children, who we need to protect, than merely puberty blockers.

[Baroness Merron (Lab)]

I certainly agree with the noble Lord about the vulnerability of children and young people in this regard, which is why we are taking this action. His last point gives me the opportunity to say that we are committed to implementing the recommendations of the Cass review in full. That is a very useful guideline and tool for us to use.

I have no expectation that the situation that the noble Lord described in his third point will happen. Recruitment is subject to all the usual provisions, and I know that the gender services will seek to recruit very positively. If the noble Lord finds out anything else, I am sure he will raise it with me.

On whether the ban could become permanent, the review—at the risk of repeating myself—will report in 2027, as the noble Lord said. I believe that we should wait for that.

[Baroness Grey-Thompson (CB)]

My Lords, like other noble Lords, I welcome the tone of the Statement. In today’s society, there is huge pressure on young people, through social media and more widely. I would really not want to be a teenager right now.

There is also huge pressure on the NHS, with multiple calls on its services. Can the Minister elaborate a bit more on how His Majesty’s Government are going to increase the number of staff and make sure they are trained to support young people? How can we support those staff? This is a tough area for them to work in. We also need to protect them from malicious complaints to make sure that they can do their job.

[Baroness Merron (Lab)]

I am glad that the noble Baroness has raised the issue of staff. It is vital that people are allowed to go about their work—as the noble Baroness, Lady Cass, should have been too—without fear of physical, verbal, online or direct abuse. I am sure that we all agree that the abuse has been an absolute disgrace. I agree about protecting those who are doing this. On the point about service, as has been said, this is about a group of vulnerable children and young people. It is our duty to provide the services to support them and to make them evidence based.

NHS: Patients with Allergies

Baroness Merron Excerpts

Thursday 12th December 2024 Grand Committee

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

My Lords, I start by congratulating my noble friend Lady Ramsey not only on securing this highly relevant debate but on shining a light on this important matter. I thank all noble Lords for their considered contributions, which were given through experience and with empathy.

As noble Lords have observed, there has been a significant rise in hospital admissions for anaphylaxis over the last two decades and it is clear how increasingly significant this matter is. That means that it is incumbent on us to lift our commitment to improving outcomes.

Anyone with an allergy, and anyone close to somebody with an allergy, knows only too well the considerable challenges and risks in everyday life, as we have heard. Very sadly, there are tragic cases of those who die from severe allergic reactions that could have been prevented. On behalf of all noble Lords, I give my heartfelt condolences to those who have lost a loved one because of a severe and sudden allergic reaction.

I thank my noble friends Lady Ramsey and Lord Mendelsohn for speaking about their children’s allergies and their experiences as parents. I also thank my noble friend Lady Keeley for making reference to her own experience. Noble Lords understand just how serious allergies can be, and the worry and anxiety, rooted in reality, that parents and loved ones feel. I too want to pay tribute to then outstanding charities that support people living with allergies in the UK, including Allergy UK, Anaphylaxis UK and the Natasha Allergy Research Foundation. They all do vital work in raising awareness, providing information and support, and funding research.

Work is ongoing across government, the NHS, voluntary organisations and patient representative groups to consider how allergy care and support could be improved. Noble Lords made reference to the Expert Advisory Group for Allergy, which was established last year, met again just last week and continues to bring together all key stakeholders in order to inform where we go next. I am most grateful to that group.

In addition, last year the MHRA launched a safety campaign to raise awareness of anaphylaxis and provide advice on the use of adrenaline autoinjectors, which have also been mentioned in the debate. A toolkit of resources for professionals to support the safe and effective use of AAIs has also been produced, along with new guidance on their use. The guidance clearly states that prescribers should prescribe two AAIs to ensure that patients always have a second dose available.

I am very pleased that Palforzia, a new treatment for peanut allergy, was approved by NICE in 2022 for those up to 17 years old to help reduce the severity of allergic reactions. The NHS is now legally required to fund this medication for eligible patients, in line with the recommendations of NICE. That means it is opening up a way for thousands of children and young people to access the medication through the NHS.

This Government are committed to improving care for people with allergies and ensuring that they get the care and support they need at the right time and access to the latest treatments. I am aware of the inequalities that my noble friend Lady Ramsey referred to in accessing allergy services. I very much acknowledge the points raised by noble Lords, particularly in respect of the workforce, delays to treatment and care, and lack of information and support that some patients have unfortunately experienced. I consider that to be a situation that cannot continue.

Noble Lords have referred today to the 10-year health plan to reform the NHS, and I am glad that noble Lords, including the noble Lord, Lord Scriven, spoke about the move from treatment to prevention. It is also about moving healthcare from hospital to the community, as well as analogue to digital. A core and central part of our 10-year plan will be the workforce, as referenced correctly by my noble friend Lady Keeley and the noble Lord, Lord Scriven, among others. In our work to prepare for the workforce that we need now and in future, it is vital that we train and get the right staff, technology and infrastructure in place. In acknowledging the points made, I absolutely recognise the need for a multidisciplinary-team approach in this area. That will be part of our considerations.

I remind the Committee that this Government have made a commitment that 92% of patients should wait no longer than 18 weeks from referral to treatment within the first term of this Government. That includes those waiting for allergy treatments. As a first step towards this, following the Budget, we will be delivering an additional 40,000 appointments this week to cover operations and scans and appointments themselves.

With regard to the point about the national lead on allergy services, I understand that there is a need to do more, as raised by the noble Lord, Lord Scriven, my noble friends Lord Mendelsohn and Lady Keeley, and the noble Lord, Lord Kamall. I am absolutely aware that there is no national lead with overall responsibility for allergy services, and of the reasons why noble Lords have raised it. My colleague Minister Gwynne is putting this under active consideration and I will certainly ensure that I raise not just this point, which has been made so regularly to him, but the other points raised in this debate. I will also raise with him the reference made by the noble Lord, Lord Scriven, to rolling out a pilot.

On the point about a meeting, raised by my noble friend Lady Ramsey, I am glad to say that Minister Gwynne met the Natasha Allergy Research Foundation just last week to discuss how care and support can be improved. The department is obviously working closely with Professor Sir Stephen Powis, the national medical director at NHS England, and, as I said, there is active consideration of the point about a national lead. I will alert my honourable friend Minister Gwynne to the point about further meetings.

Once diagnosed, and with a management strategy in place—my noble friend Lady Healy spoke to this point —patients with allergies may be able to be cared for through routine access to primary and secondary care. The Royal College of GPs has added allergy training to the new curriculum and, to support existing GPs, it has developed an allergy e-learning resource. As noble Lords will know, this Government seek to bring back the family doctor, especially for those who would benefit from seeing the same clinician regularly; obviously, that includes those with allergies.

On the transition from paediatric to adult services, which was raised by a number of noble Lords, including my noble friend Lord Mendelsohn, I absolutely acknowledge the challenge there. NICE has published guidance on the transition that we are speaking about, including recommendations on transition planning, support both before and after the transfer, and the development of transition infrastructure.

I turn to some of the additional points made in the debate; I will be pleased to write to noble Lords on the ones that I do not answer. My noble friend Lady Ramsey mentioned research. Research into allergies is funded through NICE—no, it is not. It is funded through the NIHR; I am on it. It always welcomes funding applications. We have also invested in research infrastructure; for example, Southampton Hospital is participating in a three-year trial funded by the Natasha Allergy Research Foundation.

My noble friends Lady Ramsey and Lady Healy, as well as the noble Lord, Lord Kamall, referred to a strategy on allergies. Let me clarify the situation: the National Allergy Strategy Group is developing a strategy, which will come to the department. We will consider it, and its recommendations, carefully.

The noble Baroness, Lady Burt, mentioned appropriate provision in schools in order to protect children with allergies. The Department for Education recently reminded schools of their legal duties and highlighted the Schools Allergy Code. Regulations now allow schools to obtain and hold spare adrenaline autoinjectors, and there is guidance on that.

On the important matter of prevention, as noble Lords will know, we are committed to moving from treatment to prevention. Some research shows that feeding the most common allergy-causing foods to babies and infants before the age of 12 months may prevent or reduce the chance of them developing food allergies. We will continue to look at that.

I am most grateful for this debate, which has shone an important light on this issue. I can commit to us continuing to work on this matter to improve things for those who suffer from allergies and those who are near to them.