Mental Health Bill [HL]

Baroness Merron Excerpts

Monday 17th March 2025 Lords Chamber

Moved by

[Baroness Merron]

That the Bill be considered on Report in the following order: Clauses 1 to 3, Schedule 1, Clauses 4 to 23, Schedule 2, Clauses 24 to 39, Schedule 3, Clause 40 to 56, Title.

Motion agreed.

Primary Healthcare Facilities

Baroness Merron Excerpts

Monday 17th March 2025 Lords Chamber

[Baroness Pitkeathley]

To ask His Majesty’s Government what steps they are taking to accelerate the construction of primary health care facilities to facilitate patients moving from hospital to community care.

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

My Lords, the Government are committed to fixing the front door of the National Health Service. This includes working with providers to deliver the primary care infrastructure required to enable a neighbourhood health service. We have already taken steps, including providing over £100 million of capital funding in 2025-26 to upgrade GP buildings—the first dedicated national capital fund for primary care since 2020. Spending plans for future years will be confirmed later this year.

[Baroness Pitkeathley (Lab)]

I thank my noble friend the Minister for that helpful answer. The limited capacity of GP premises, as highlighted in the Darzi report, is hindering the service’s ability to meet growing patient demand for face-to-face contact with the general practitioner and the primary care team, as well as obstructing the move to community care. Therefore, I have two specific questions for the Minister. First, will the Government make primary care infrastructure a priority when the very welcome new housing developments are being planned? Secondly, will the Government encourage the use of existing community premises, such as community centres and village halls, which could be temporarily adapted for primary care purposes until sufficient, purpose-built centres are available?

[Baroness Merron (Lab)]

I can assure my noble friend that we are working closely with the Ministry of Housing, Communities and Local Government to raise the importance of primary care provision in the planning process, as my noble friend has highlighted. That is to influence the direction of local plans, as well as maximise contributions from developers. We very much support using existing community spaces, which is a creative solution to deliver primary healthcare services, and we are exploring through the 10-year health plan how to further support the integration of services into the wider public estate to improve access. Indeed, we will consider all solutions, including the ones that my noble friend highlights.

[Lord Kakkar (CB)]

My Lords, I draw noble Lords’ attention to my registered interests. The Minister will, I am sure, agree that, beyond physical infrastructure, one of the most important impediments to ensuring that there is effective integrated care between secondary and primary care settings is the question of regulation—professional and institutional regulation—which is quite different across those institutional boundaries. What plans do His Majesty’s Government have to look at the question of regulation to improve integrated care as part of their broader review of the delivery of healthcare in our country?

[Baroness Merron (Lab)]

The noble Lord is right to highlight regulation. Of course, there are many other aspects beyond physical infrastructure: for example, the use of technology, which also supports the subject on which we are speaking. All these matters are being considered as part of the 10-year plan and I am sure we all look forward to that reporting.

[Baroness McIntosh of Pickering (Con)]

My Lords, is the Minister aware that there is a network of community hospitals which survives? Will she therefore use some of the funds to ensure that these community hospitals remain in place, so that, after a stroke or treatment, patients will be made fit to enable them to return home?

--- Later in debate ---

[Baroness Merron (Lab)]

There are indeed many aspects of community care, as the noble Baroness refers to in terms of community hospitals. I emphasise that we are moving towards a neighbourhood health service, with more care delivered locally to create healthier communities, to spot problems earlier and to help people stay healthier for longer. It is of course up to local health systems to decide how best to serve their local communities, and services will vary according to where they are across the country.

[Baroness Tyler of Enfield (LD)]

My Lords, as part of the shift from hospital to community, what specific plans do the Government have to set up more walk-in diagnostic centres and polyclinics as a way of allowing quicker and easier access to joined-up healthcare for patients, giving them greater control and reducing current pressures on GP surgeries and hospitals?

[Baroness Merron (Lab)]

We will be providing further details in the national implementation programme, but I can say that neighbourhood health guidelines have already been published to help ICBs, local authorities and health and care providers to continue to progress neighbourhood health. We will trial neighbourhood health centres to bring together a range of services, and others that the noble Baroness refers to, to ensure that healthcare is closer to home and that patients receive the care they deserve when and how they need it.

[Lord Kamall (Con)]

My Lords, we know that the Government are keen to encourage more investment into our national infrastructure—which these Benches welcome. Given that, what conversations are the Department of Health and Social Care and the Treasury having with pension funds and other funds on investing in neighbourhood primary health and care facilities, and indeed in other parts of our system of health and social care?

[Baroness Merron (Lab)]

Although I cannot give a specific answer to the noble Lord on that point, I will be happy to look into it. As I mentioned earlier, in our discussions with the Ministry of Housing, Communities and Local Government we are, for example, looking at how we can lever greater contributions from developers who are working on new developments, where they will be providing much-needed health services and infrastructure. So we are taking a creative approach because we recognise the need to do more.

[Baroness Winterton of Doncaster (Lab)]

My Lords, my noble friend referred to creativity and the noble Baroness on the Lib Dem Benches talked about facilities in the community. Well, in Doncaster, we are already ahead of the game, as Mayor Ros Jones has worked with the local health community to provide a “health on the high street” facility, which will not only reduce pressure on the hospital but make it easier for patients to access services and, crucially, help regenerate the city centre. Will my noble friend join me in congratulating Mayor Ros Jones on this initiative, but also work with the local community to address the issue of urgent repairs that are still needed at the hospital?

[Baroness Merron (Lab)]

I am very pleased to congratulate Mayor Ros Jones on this initiative, as I would be pleased to congratulate such initiatives up and down the country. My noble friend is right to talk about the great benefits to local communities, which I myself remember, as will my noble friend, from the previous Government, in terms of walk-in health centres, which made a huge difference. To the point about repairs to the local hospital, it is vital, if we are to create the right NHS going forward through the 10-year plan, that we repair and rebuild the healthcare estate, which has a very considerable backlog maintenance bill after years of underinvestment. That is why the Chancellor confirmed extra investment for the backlog of critical NHS maintenance and repair upgrades.

[Lord Laming (CB)]

Does the Minister agree that success depends on quite sophisticated co-ordination of different services employed in different organisations? That includes not just community nurses but home helps, specialist hospital-type equipment, the whole range of adaptions to property, and the like. Can the Minister assure the House that these things will be properly considered as we go forward to try to improve the movement from hospital to the community?

[Baroness Merron (Lab)]

I certainly agree and can reassure the noble Lord that this is the case. I know that your Lordships’ House will have heard me speak previously about the very considerable investment that the Chancellor committed to in the Budget to provide adaptions for people’s houses in order that they could be cared for at home. I also say to the noble Lord that integrated care systems infrastructure strategies have been developed, which will create a long-term plan for future estate requirements and investment, while community health services also provide for planned and urgent care close to home, including clinics, care homes and, to the point raised by a previous noble Baroness, community hospitals.

[Lord Turnberg (Lab)]

My Lords, the biggest problem is the shortage of GPs. We are losing them faster than we are recruiting them. What plans do the Government have to increase the number of general practitioners?

[Baroness Merron (Lab)]

I am glad to say that recently, as my noble friend will be aware, we concluded the annual consultation on the GP contract and the committee voted in favour of the contract for the first time in four years. That will provide a way forward in terms of strengthening provision, prevention and the integration of services, which I hope will lift morale and the attraction to being a GP. We want to see consistent growth. There are now over 1,000 more full-time equivalent doctors working in general practice compared with January 2024. We have committed to training thousands more GPs across the country and recruiting over 1,000 newly qualified GPs through an £82 million boost to the additional roles reimbursement scheme.

Food and Feed (Regulated Products) (Amendment, Revocation, Consequential and Transitional Provision) Regulations 2025

Baroness Merron Excerpts

Wednesday 12th March 2025 Lords Chamber

Moved by

[Baroness Merron]

That the draft Regulations laid before the House on 29 January be approved.

Relevant document: 17th Report from the Secondary Legislation Scrutiny Committee (special attention drawn to the instrument). Considered in Grand Committee on 10 March

Motion agreed.

Apricity Fertility Closure

Baroness Merron Excerpts

Wednesday 12th March 2025 Lords Chamber

[Baroness Owen of Alderley Edge]

To ask His Majesty’s Government what assessment they have made of the effect of the closure of Apricity Fertility on 1 January on the patients who were undertaking treatment with them.

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

My Lords, the Human Fertilisation and Embryology Authority advised the department about the closure of Apricity in December. Apricity did not fall under the HFEA’s regulatory remit, as it was only a digital service. I urge anyone seeking fertility treatment to check that the clinic they are using is HFEA licensed. I advise affected patients in this case to check their consumer rights and engage with trading standards, if needed. More broadly, the HFEA is helpfully providing advice.

[Baroness Owen of Alderley Edge (Con)]

My Lords, Apricity Fertility advertised itself as:

“The UK’s Top Virtual IVF Clinic”.


As the Minister pointed out, it was not regulated by the Human Fertilisation and Embryology Authority, which by law can regulate only UK-licensed fertility clinics, which are the premises where treatments take place. Will the Minister commit to a review of the HFEA’s powers to ensure they are appropriate for digital services?

[Baroness Merron (Lab)]

As the noble Baroness will be aware, in November 2023 the HFEA published Modernising Fertility Law, in which it made a number of recommendations for urgent change, including around its regulatory powers. I will meet the HFEA chair and CEO tomorrow, and we will further discuss the regulatory challenges that the HFEA faces. I assure the noble Baroness that the Government are currently considering the HFEA’s priorities, including its role with digital clinics such as the one referred to, should an opportunity for legislative reform arise.

[Lord Winston (Lab)]

My Lords, the noble Baroness, Lady Owen, asks a most important Question, and I am grateful to my noble friend the Minister for answering it at least partially. I argue that much more of an answer is needed. Apricity advertised a success rate that was literally impossible; indeed, it was more than double the national success rate. Again and again, patients are being sucked into in vitro fertilisation—which may not always be the best treatment for them, just because they are infertile—because they think they will have a better chance of success than they actually have. It is time to be much more rigorous. As my noble friend the Minister is seeing the HFEA chair tomorrow, will she ask her how well the HFEA feels it is auditing the results it gets from clinics? In my view, many clinics are exaggerating, in all sorts of ways, what the success rate is.

[Baroness Merron (Lab)]

My noble friend raises an extremely important point, which I will of course cover in my meeting tomorrow. It may be of interest to know that the Advertising Standards Authority and the HFEA issued a joint enforcement notice in 2021 to ensure that fertility clinics and others were aware of the advertising rules and were treating consumers fairly. That remains in place. The ASA periodically reviews compliance with its rules. Its recent review in the fertility sector found far fewer absolute claims than it had found previously and that the level of compliance is good. That is not to say that it is good in all cases, and I agree with my noble friend’s point.

[Baroness Barker (LD)]

My Lords, the law governing human fertilisation and embryology in this country built on the outstanding work of Baroness Warnock. It was carefully crafted so that it rests on principles that endure, but it was designed in such a way that it could be regularly updated to deal with advances in scientific knowledge and changes in society. Does the Minister agree that this is an indication that we have come to a point where that legislation needs to be reviewed? In order to do that, will the Government commit to beginning the process of consultation that must take place before any legislative review comes to this Chamber?

[Baroness Merron (Lab)]

I agree with the noble Baroness’s observations. The legislation goes back to 1990. We are in 2025, and there has been an advent of many new technologies, techniques and business models—for example, the noble Baroness, Lady Owen, referred to Apricity—that were never imagined just a few years ago, let alone in 1990.

The majority of clinics are privately owned. Many are part of large groups with external finance. Elements of fertility care and associated treatments are increasingly offered online or outside HFEA regulation. There is a huge challenge here. That is why we are in discussion with the HFEA, and we will be in discussion tomorrow.

[Lord Kamall (Con)]

My Lords, the Minister will recall that in 2022 the previous Government published the 10-year Women’s Health Strategy for England. During the consultation process, it came out that access to fertility services differs greatly across the country—possibly one of the reasons that many women went to Apricity in the first place. Part of the solution that was proposed to tackle these disparities was a target to establish women’s health hubs. I understand that the current Government have decided not to go ahead with these women’s health hubs. My question is not why, but how the Government envisage tackling these disparities without women’s health hubs. What is the strategy for doing that?

[Baroness Merron (Lab)]

Women’s health hubs—which are a huge success and we continue to support and promote them, without any shadow of a doubt—do not deal with fertility treatment in the way this Question is discussing. I gently point out to the noble Lord that, as he rightly said, commitments were made to improve access to fertility services, which is very variable across the country. They were made under the last Government’s women’s health strategy but, regrettably, were not delivered. It now falls to us to look at how we can improve both availability and quality, and to equalise what is available, which is a huge challenge. This continues to concern me.

[Baroness Deech (CB)]

My Lords, I declare an interest as a former chair of the HFEA. The problem the Minister has referred to is increasing commercialisation. Vulnerable patients are more or less captured by clinics—for example, by being charged ever-increasing amounts for the storage of their embryos. How can the Government get to grips with the market element in an area that is largely private? Can they encourage the NHS? I know the difficulty of taking on more. What legislation can there be to control this commercialisation and the huge amount earned by the private doctors?

[Baroness Merron (Lab)]

The noble Baroness and other noble Lords are quite right in what they are reporting on the change. Fertility treatment is now overwhelmingly obtained through private means. It is in a very different place from the rest of healthcare in our country.

On the point the noble Baroness made—I am grateful for her contribution in view of her previous service in this area—there are many claims made, for example, about egg freezing. It is crucial that anyone considering freezing their eggs understands that there is an optimum age for freezing, that it is a serious medical procedure and that the risks should be taken into account. That chimes with the point made by my noble friend Lord Winston.

The market has changed—it has very much become a market. The demand is huge and has multiplied many times over the decades. We are not in a situation where we have either the regulation or the NHS provision to deal with that. I assure your Lordships’ House that we are working with NHS England, particularly on the variability up and down the country.

[Baroness Manzoor (Con)]

My Lords, the Minister is right that the market has changed, but the legislation has not been kept up to date; nor has it kept up to date with patient expectations, developments and the way those services are being provided for some of these women. Often, some of these women are vulnerable. Can the Minister say exactly what the Government will do to update not only the regulations but the law?

[Baroness Merron (Lab)]

In my discussions, I will consider the publication Modernising Fertility Law, which, as I said, the HFEA put forward in November 2023. In it there are a number of recommendations for urgent change, which I am taking extremely seriously. Most patients are funding their own treatment, which is why we have to make a shift. In 2022, 27% of IVF cycles were funded by the NHS; that figure fell from 40% in 2012. That gives some idea of the scale of the challenge. I consider it unacceptable that access to NHS-funded fertility services is so variable across the country.

Autism and Learning Disabilities: Hospital Detention

Baroness Merron Excerpts

Tuesday 11th March 2025 Lords Chamber

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

My Lords, this Question refers to a very sad and concerning story. This Government want more people with a learning disability and autistic people to be supported in the community, not detained in mental health hospitals. That is why we are proposing reforms to the Mental Health Act, which this House is currently scrutinising. Through this, we want to help ensure that people get the support they need in the community, improving care and keeping people out of hospitals.

[Baroness Tyler of Enfield (LD)]

I thank the Minister, and I am sure the whole House was appalled by this shocking case, which came to light only due to a BBC investigation. Does the Minister agree that to prevent such a terrible situation arising again, we cannot just wait for the Mental Health Bill to get on the statute book with its current five- to 10-year implementation period? What immediate plans do the Government have to set up a system to review long-term detentions? Does the Minister agree with me that a mental health commissioner, currently under debate in the Bill, could take on this role?

[Baroness Merron (Lab)]

I am grateful to the noble Baroness for tempting me to agree with her comments about a mental health commissioner. We have debated that, and the noble Baroness is aware that we do not feel that this is the right way forward. However, I am sure we will return to that on Report.

With regard to not waiting for the Mental Health Bill to become an Act, of course I agree. The number of people with a learning disability and autistic people who are in mental health hospitals is unacceptable, and there are still too many detained who could be supported in their communities. We have taken immediate action in allocating funding to local areas: £124 million for learning disability and autism services. We are making sure that the workforce has the right skills and knowledge through work such as the HOPE(S) model. We are providing for the CQC to deliver independent care (education) and treatment reviews. NHS planning guidance provides a continued focus on improving mental health and learning disability care, with an objective to deliver a minimum—I emphasise minimum— 10% reduction in the use of in-patient care.

[Baroness Hollins (CB)]

My Lords, for 25 years, this woman’s detention was in long-term segregation. My review of this practice, which was commissioned by the previous Government, recommended that people in LTS must have an independent review, should have national support to reduce confinement, and be allocated an independent project manager to co-ordinate their timely discharge. But despite the unequivocal success of the ICETR programme, the HOPE(S) intervention and senior intervenors’ support, funding has been cut at the end of this year. Will the Government commit to funding these vital initiatives to end this rights-depriving restrictive practice?

[Baroness Merron (Lab)]

I am most grateful to the noble Baroness for her contribution and expertise in this area, which I know we all look to in your Lordships’ House, as well as outside it. The points she makes are quite right and important. On this particular case, which is very sad and concerning, I understand that the person is now living in the community with 24/7 care and has been since 2022. I saw at Rampton how people were being supported out into the community with the right support. On the example the noble Baroness gave, we are very keen to improve the uptake of advocacy services, and she will know that all these matters are being addressed in our discussions on the Mental Health Bill.

[Baroness Ramsey of Wall Heath (Lab)]

My Lords, I refer to my particular interest in this subject as the younger sister of a woman with severe learning difficulties who was detained in a hospital for many years. Is my noble friend the Minister confident that this sort of tragic lengthy detention of a non-verbal woman with both autism and learning disabilities will be prevented in future by the register proposed in the Mental Health Bill to be established and maintained by integrated care boards?

[Baroness Merron (Lab)]

Yes, because we are, as my noble friend knows, updating an Act that is over 40 years old, to keep pace with demands and changes, and to meet our expectations of providing care through a compassionate and appropriate service. There were particular circumstances in this case, which I do not seek to excuse, but it is not appropriate for me to go into them. It is important to look at specific cases.

[Baroness Monckton of Dallington Forest (Con)]

My Lords, there are over 2,000 people with autism and learning disabilities locked up in these facilities at huge cost. Putting them into the community does not necessarily work because the infrastructure is not there. Will the Minister commit to funding the necessary care and housing for this cohort?

[Baroness Merron (Lab)]

The noble Baroness is quite right to raise the fact that at the end of January 2025 there were some 2,065 people with a learning disability, autism, or both, in mental health in-patient settings. The population I referred to is not a static one; there are new admissions every month. We know, for example, that in January 2024, some 10,000 discharges to the community had been undertaken since 2015. So it is not necessarily the same group of people. She will know that funding decisions are made at the appropriate point. Again, this is a matter of great importance to the Mental Health Bill, and we will continue to take that through the House to get it into the best place possible.

[Lord Kamall (Con)]

My Lords, during the 45 years that this poor autistic lady with learning disabilities was detained and the 25 years she was in segregation, we have had Governments of all political colours, so this is clearly not a political issue. Indeed, I remember the Minister challenging me on such detentions when I was in her place. Given that, are the Government any closer to understanding the barriers that prevent such patients from being released into the community? Rather than assuming that the state always has a solution, have the Government and the NHS had conversations with local community civil society organisations so that they can support these patients once they are released into the community?

[Baroness Merron (Lab)]

This matter is one of concern on all sides and yes, indeed, we continually have those discussions, because this is not just something for the NHS and social care—the third sector is absolutely key. I have already outlined the measures we are currently taking and the way in which we continue to monitor.

On the question about obstacles, it is about having the right community provision in place and also about having the right pathway and treating people as individuals. Increasingly, that is the case, and a revised Mental Health Act will be a tremendous support in this area.

[Lord Laming (CB)]

My Lords, I hope the Minister will agree that the use of the Mental Health Act in these circumstances should be a last resort and a minimal experience. What happened to this lady is no credit to our society as a whole. Can the Minister say what steps have been taken since this lady’s experience came to light to ensure that other people are not subject to the same experience? We really need to learn from this experience.

[Baroness Merron (Lab)]

Regrettably, that person’s experience is not a lone example. That is why, for example, the Mental Health Bill will limit the scope to detain people with a learning disability and autistic people, so that they can be detained under Section 2(3) only if they have a co-occurring mental disorder that requires hospital treatment. That is key because, in the times that we are talking about, people were detained just because of autism or a learning disability. That is not acceptable.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, I welcome my noble friend the Minister and advise her that your Lordships’ House has a specialist committee that is dealing with the review of the Autism Act 2009. I encourage my noble friend and her ministerial colleagues, both in health and social care and in education, to undertake a review of that Act to ensure that it is fit for purpose, for the needs of autistic people.

[Baroness Merron (Lab)]

I am very grateful to the committee for its work and I am certainly looking forward to its report. The Government will respond to that report within two months. It is indeed vital work that is being undertaken.

Food and Feed (Regulated Products) (Amendment, Revocation, Consequential and Transitional Provision) Regulations 2025

Baroness Merron Excerpts

Monday 10th March 2025 Grand Committee

Moved by

[Baroness Merron]

That the Grand Committee do consider the Food and Feed (Regulated Products) (Amendment, Revocation, Consequential and Transitional Provision) Regulations 2025.

Relevant document: 17th Report from the Secondary Legislation Scrutiny Committee (special attention drawn to the instrument).

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

My Lords, these regulations were laid before the House on 29 January. This draft SI uses powers conferred by the Retained EU Law (Revocation and Reform) Act 2023 to propose two reforms to the market authorisation process for regulated food and feed products in Great Britain. The first is the removal of the requirement for certain products to be reauthorised every 10 years, and the second is to allow authorisations to come into effect following ministerial decisions and to then be published in a public register, rather than prescribed by statutory instrument. The reforms are very much related to process.

These reforms are part of this Government’s mission to kick-start economic growth by increasing investment, driving up productivity and tackling regulatory barriers—something that I know noble Lords are concerned with. The UK food industry is worth some £245 billion in consumer spending annually. It is driving innovation, particularly as the UK’s growing engineering biology sector harnesses emerging technology to produce novel foods.

Regulated products are food and feed products that require safety assessment before they can lawfully be sold. The Food Standards Agency and Food Standards Scotland carry out this assessment and provide recommendations to Ministers across Great Britain on the authorisation of products. Innovation and growth across the food sector is increasing demand for authorisations. We need proportionate regulation to support investment, while maintaining safety and consumer trust. This statutory instrument removes requirements that are unnecessary for food safety without compromising it.

On renewals, certain authorised products must currently be reauthorised every 10 years. This SI removes that requirement. Instead, safety reviews will be carried out when necessary. The service will be more efficient if regulators focus on detailed reviews of products that potentially pose risk, instead of reassessing products that have many years of safe use.

The FSA and the FSS have earned public trust through rigorous risk analysis. These reforms build upon regulators’ existing powers to request safety information. They enable an efficient approach, where the regulators respond effectively to emerging risks. I emphasise that, where necessary, approvals can be modified, suspended or revoked. Food safety will continue to be the priority.

Although steady progress is being made, it is fair to say that the FSA and the FSS are not processing as many applications as are coming in. This is causing an increasing backlog, which is of concern. There are 481 current applications; although 97 applications have been completed since 2021, the caseload is growing, not reducing. Of those 481, about 100 are renewals, with almost 500 additional renewals expected in the next three years. This has to be dealt with. While the FSA and the FSS have implemented measures to improve the service within current legislation, it is essential that the service and the system are modernised. Removing automatic assessment for renewal allows a more targeted approach.

I turn to the removal of SIs. The second part of these reforms allows authorisations to come into force following ministerial decisions and to be published in a public register, rather than being prescribed by an SI. This will enable new products to be brought to market more quickly, without, I emphasise, compromising safety. Publishing authorisations together in online registers, rather than in complex legislation, will make finding information on authorised products more accessible than currently. This aligns with other UK regulators’ authorisation processes, such as for veterinary medicines and pesticides.

The FSA and the FSS provide scientific scrutiny through expert staff and independent scientific advisory committees. They provide safety assessments, risk management advice and recommendations for ministerial decisions. This process aligns with internationally recognised principles. The FSA and the FSS will publish risk assessments and authorisations, in line with their commitments to transparency. The statutory obligation to consult will not change, and authorisations will continue to be subject to public scrutiny.

I assure noble Lords that there has been extensive engagement with industry and consumer groups, including through public consultation. The reforms have received substantial support. The Secondary Legislation Scrutiny Committee was reassured by the FSA’s responses to questions raised during scrutiny. I have responded to those primary areas of focus in this opening speech.

These reforms prioritise efficiency and safety, focusing resources on innovative products. I hope noble Lords will feel able to support these reforms, which will create a service which manages risk in a proportionate fashion, without compromising our high food and feed safety standards. I beg to move.

[Baroness Coffey (Con)]

My Lords, I welcome these regulations, on several grounds. First, as the Minister mentioned, this is a deregulatory approach. There cannot be many regulations deemed to be deregulatory that have 104 pages, but 70 of those pages deal with revocations of existing legislation. That is to be welcomed.

I completely support that this will be a risk-based approach. I am conscious that consultations are ongoing on products being considered by the FSA under this approach. I am conscious that some may be concerned about removing the need for separate secondary legislation, which is a hangover from our days in the European Union, but this is perfectly routine.

I have a couple of questions for the Minister. First, I am conscious that the Food Standards Agency is a non-ministerial department, with the DHSC leading on this in government and in Parliament. Can she confirm whether DHSC Ministers will be making these decisions or whether it will be open to Defra Ministers?

Secondly, an issue that arose during the passage of what is now the precision breeding Act was concern that the devolved Administrations would be reluctant to have any GMO in products sold in their countries. The purpose of the United Kingdom Internal Market Act and the non-discrimination principle was to make sure that, where something had been given the go-ahead in England, say, it could be sold anywhere across the United Kingdom, respectful of the devolved Administrations but nevertheless giving consumers that choice. Will the UK Government fully assert the non-discrimination principle in the sale of future products? As I said, I support these regulations.

--- Later in debate ---

[Lord Kamall (Con)]

My Lords, I welcome the noble Lord, Lord Moraes, to his place. We served together in the European Parliament, of which he was a well-respected member. I thank the Government for sending out so many big guns—I think I count six on the Front Bench in this Room. I will not flatter myself that they are here for me, but I am impressed by how seriously the Government are taking this statutory instrument.

I thank the Government for addressing the concerns of the Secondary Legislation Scrutiny Committee. The noble Baroness, Lady Walmsley, rightly said that questions were not answered, but it is good that the Government were able to address those concerns, and we are grateful for that. Like my noble friends Lady Coffey and Lady McIntosh of Pickering, I think that these Benches generally welcome measures to streamline processes, but I understand potential concerns over the safety and oversight of regulated products. As the saying goes, one person’s safety standards may be another’s red tape. That was something that the noble Baroness, Lady Bennett, alluded to.

We welcome that there was a consultation between April and June 2024. I understand that, while there was broad agreement in principle, there were some concerns and disagreements, which I would like to ask the Minister about today. Before I do that, I shall pick up on the issue of GMOs. Let me clear—I have nothing in principle against GMOs, but for consumers it is important that there is labelling, so that they can make that choice in an informed way. When we were in the European Parliament and negotiating the Transatlantic Trade and Investment Partnership with the US and made the point about labelling GMOs, what was interesting was that the US negotiators would say, “That’s a non-tariff barrier”. If the Government intend to label GMOs, is that an issue that will be brought up in future trade negotiations? The Minister may not be able to answer that immediately, but perhaps she can write to us about it, or ask her colleague who is taking through trade issues at the moment.

The Government claim that these changes will provide businesses with quicker approval times, increasing the return on investment and stimulating innovation. That is of course to be welcomed, but we should always be aware of two things. What happens in the case of negative unintended consequences, and what happens if new evidence comes to light that shows that a product authorised under these terms presents previously unforeseen risks to public health or the environment? That is something that other noble Lords referred to. In a situation where regular renewals are no longer required, can the Minister assure your Lordships if and how products covered by this regulation will be reassessed, if any new data emerges that suggests that they are not as safe as originally thought, especially if these products are already on the market?

I understand that the Food Standards Agency and Food Standards Scotland have the power to conduct evidence-based reviews if new information surfaces, but can the Minister assure us that a less regular review mechanism will not compromise safety? I think that she mentioned the phrase “where necessary”. Can she put more meat on the bone and explain a bit more what that means? What mechanisms are in place to ensure that products remain compliant with safety standards over time? We know that regulation is often outpaced by innovation, so how do the FSA and the FSS plan to stay ahead of new risks or scientific developments with less regular oversight than these renewals once provided?

The second potential concern is that the Government do not appear to have conducted a formal impact assessment of these proposals. Given that these regulations will affect a significant number of products and legislative instruments, could the Minister tell noble Lords whether it is correct that no formal impact assessment was conducted and, if not, why not? Was there an informal impact assessment of any kind, and why was it decided that no formal impact assessment would be needed? Can the Minister assure the public that the full range of potential risks and benefits has been properly assessed?

Finally, as noble Lords may know, I spent 14 years in the European Parliament—not as long as my friend, the noble Lord, Lord Moraes. I was often frustrated by EU regulations, because they were more often than not based on the precautionary principle, or the over-precautionary principle, rather than the innovation principle. It is important that we get the balance between innovation and precaution right—I welcome that. I am not necessarily against divergence between UK and EU regulations, especially when it allows innovation, but could the Minister tell your Lordships what conversations the Government have had with EU counterparts and colleagues in Northern Ireland about the potential impact of these regulations on the Windsor Framework?

Overall, while these Benches welcome the regulations, I hope that the concerns expressed during the consultation, and today by other noble Lords, can be addressed by the Minister.

[Baroness Merron (Lab)]

My Lords, I thank noble Lords for their valuable and considered contributions to the debate today. I re-emphasise the main point I made in my opening comments: removing automatic renewal processes and statutory instrument requirements will not lower food safety or standards. I am grateful for the support from the noble Baroness, Lady Coffey, and for her bringing to bear her experience across relevant departments, as well as from the noble Baroness, Lady McIntosh, and the noble Lord, Lord Kamall.

I have heard a number of concerns, including from the noble Baronesses, Lady Bennett and Lady Walmsley. I understand the points made, and I hope that I can reassure them further from my opening comments. I am very happy to follow up where I have not got the ability, time or wherewithal to answer the questions.

The noble Baroness, Lady Coffey, asked about ministerial decision-making and the assertion of the non-discrimination principle. These reforms do not change what is in place to maintain the functioning of the internal market Act. Differences in approach will continue to be managed through the relevant common frameworks. I reassure not only the noble Baroness but other noble Lords that the FSA and the FSS are strongly committed to achieving a four-nation consensus, in line with our commitment to the food and feed safety and hygiene common framework. Decisions by Ministers in England—which will be from the Department of Health and Social Care, to the point brought up by the noble Baroness—as well as Scotland and Wales, will still be required for authorisations in their respective nations.

The noble Baroness, Lady McIntosh, asked about processes that will be followed with the removal of the renewals process. This SI does not change current GMO labelling requirements, which I know was another matter of concern to other noble Lords. Products that contain or consist of GMOs must be clearly labelled as defined in current legislation. Nothing will change in that regard. Following the reforms, businesses will continue to be required to notify the FSA and the FSS, if they have any new information which might affect the suitability of a validated laboratory-based method for the identification, detection and qualification of GMOs, something that the noble Baroness, Lady Bennett, was also concerned with.

To the point about the SLSC, it is suggested that the House may wish to consider the steps proposed to maintain parliamentary oversight. However, proportionate processes are in place for sufficient scrutiny of authorisation decisions, such as public consultation and the publication of safety assessments and authorisations. It is an important point that the authorisation process remains open and transparent. The SLSC recognised that this aligned with the processes used by other UK regulators.

[Baroness McIntosh of Pickering (Con)]

I do not wish to labour the point too much, but when a statutory instrument is presented to this Committee, we have the opportunity as parliamentarians to look at it. How will we be informed of the renewals if they are on a register? Do we have to ask someone to notify us? How do we know? At the moment, it is automatic; in future, it will not be.

[Baroness Merron (Lab)]

I understand the point the noble Baroness is making. I will turn to the point about the availability of information, which was also the point that the noble Baroness, Lady Walmsley, made. However, details of applications and authorisations will actually be more publicly available than they are currently. I hope that will be helpful. Of course, as we know, Ministers must provide reasoning if they disagree with FSA and FSS advice when they are making their decisions. In order for the public and anybody—including Parliament—to scrutinise regulated product applications and authorisations, all those tools and resources will be available.

The noble Baroness, Lady Walmsley, suggested a reporting mechanism. I am happy to look at that and will take into account what she said. But I say to noble Lords—and I know they know this—that statutory instruments are not the only way in which to hold matters to account, nor are they always the best way to ensure transparency and openness. We are seeking to be more transparent and ensure that we make this an easier place for industry, the public and others to work in—which most noble Lords welcomed.

--- Later in debate ---

[Baroness Bennett of Manor Castle (GP)]

There may be a legal obligation on companies to act, but we have seen again and again that, with the profits versus the costs of them identifying a problem and being prepared to go public and go to the Government about it, the legal requirement is not much of a safeguard.

[Baroness Merron (Lab)]

I understand that. It is why these reforms build on existing powers, whereby the FSA and FSS can request information for the review. It is of course in the interests of businesses to proactively provide it. As I mentioned in my opening remarks, where necessary, approvals can be modified, suspended or even revoked if a safety concern has been identified. That will not change.

To return to the point I was making previously, when, or if, new safety evidence emerges, it will inform whether authorised products are safe to remain on the market at any time, instead of—this is the reason for this statutory instrument—working to arbitrarily fixed renewal timetables, which burden industry and the public sector with comprehensive reviews for all products, whether they are needed or not, even when there is no evidence to suggest that one is needed. The evidence shows that this move is generally in the desired direction to be working.

The noble Baroness, Lady Walmsley, asked whether more should have been done in the Explanatory Memorandum to point out issues. As I listened to her, I wished that we could all predict what needs to be answered. Importantly, the FSA responded to all the questions raised by the SLSC, which was reassured by the responses. I hope that noble Lords agree that the FSA has been most helpful there.

On the question asked by the noble Baroness about sufficient resources and systems, it is anticipated that a relatively small number of authorisations will require a review on the basis of safety, as compared to the large number of renewals currently processed. I would expect that to be very manageable.

The noble Baroness also asked whether reports are always sent, whether they are always complete and whether that would give confidence. An evidence-based review system will ensure that already-authorised products are reviewed based on risk and new evidence rather than, as I said, on a fixed timetable. Reports are indeed provided and completed, but this change will make that even more doable and meaningful, and that is the reason for the change.

As I said earlier to the noble Baroness, Lady Walmsley, who made a suggestion about Written Statements being made, I will certainly take that away and reflect on it—as I will do for all of the points that were raised. With that, I thank noble Lords for their interest in and scrutiny of this SI.

Motion agreed.

Prostate Cancer: National Screening Programme

Baroness Merron Excerpts

Thursday 27th February 2025 Lords Chamber

[The Lord Bishop of St Albans]

To ask His Majesty’s Government what plans they have to introduce a national screening programme for prostate cancer.

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

My Lords, we are investing £16 million in the Prostate Cancer UK-led TRANSFORM trial to look for better tests than we have currently. Evidence shows that the current best test available, the PSA test, is not accurate enough to use in men without symptoms. As noble Lords will appreciate, policies must be evidence-based, so the UK National Screening Committee is actively reviewing the evidence for prostate screening programmes and will complete its review this year, to be followed by consultation.

[The Lord Bishop of St Albans]

My Lords, I declare an interest, in that just a year ago I was unexpectedly and rapidly diagnosed with prostate cancer and received wonderful treatment from the NHS, to which I pay tribute today. Some 12,000 men die each year, many needlessly, because of late diagnosis. It is a postcode lottery. It is quite clear that in areas of socioeconomic deprivation, and among black men between the ages of 45 and 70, there is a much higher incidence. When can we expect to hear news about a national screening programme? What assessment is being made of the new tests that are being reported at the moment, which are much more successful in diagnosis?

[Baroness Merron (Lab)]

My Lords, I am glad to hear that the right reverend Prelate had such good care in the NHS. His comments are appreciated, and we are very pleased that things have out turned so well for him. The issue, as I know he will he understand, is that we cannot offer an inaccurate test to high-risk groups, not least because that increases the risk of adverse effects, unnecessary treatment and misdiagnosis. We are not yet in a scientifically and evidence-based position to offer the national screening programme, and that is why we are taking the action that I outlined in my Answer.

[Baroness Walmsley (LD)]

My Lords, while we wait for a more reliable screening tool, what are the Government doing to inform men about the very clear risk factors that are known about? To that I would add that maintaining a healthy weight reduces the risk. Additionally, what can the Minister do to reassure men that, if they are in any way worried about any symptom, they are not wasting their GP’s time if they go along and get it checked out?

[Baroness Merron (Lab)]

The noble Baroness is absolutely right. I encourage everyone, men and women, to be aware of any changes in their bodies. They are not wasting the time of their GP. That is exactly what they should do. As she says, men are disproportionately affected by a number of health conditions, including some cancers, heart disease and type 2 diabetes. As part of addressing this, the Secretary of State has announced that we are developing a men’s health strategy, not least because we know that men are less likely to come forward to deal with health matters.

[Baroness Manzoor (Con)]

My Lords, in the absence of a national screening programme and given the difficulty in getting access to GPs, particularly in deprived areas, how are the Government improving access to GPs? In some areas, it is two to three weeks before people can get an appointment.

[Baroness Merron (Lab)]

Again, I am sure that the noble Baroness would agree that the important thing is that people ensure that they do not ignore the situation. I agree that the situation that we inherited was hugely difficult, particularly in some areas, around GPs. In the 10-year plan, which will be published in the coming months, there will be a big focus on the move from sickness to prevention, from analogue to digital, and from hospital to community. In all three pillars, greater access to GP appointments will be included.

[Baroness Finlay of Llandaff (CB)]

My Lords, as the Minister rightly highlighted, there are detection gaps, and one in 50 people have aggressive disease at the time of diagnosis. When this proves to be hormone-therapy or chemotherapy resistant, how many centres can offer strontium, which can be very effective for metastatic bone pain, as that is how some people present?

[Baroness Merron (Lab)]

I was glad to have the opportunity to discuss this with the noble Baroness. Having looked into it, we do not currently hold this data. However, where strontium therapy is appropriate and preferred to improve patient outcomes, it will be offered. This is, of course, a clinical decision.

[Lord Kamall (Con)]

My Lords, when I worked in Belgium, a urologist told me that men over 45 years old should seek a test every year for this. When I came back and asked my GP, he was dismissive of that, saying that I should seek a PSA test. When I asked a nurse at my next blood test for a PSA test, she said, “Are you sure? They’re not very reliable”. Given that the last Government introduced trials, and that one of the tests seems to be 96% accurate, can the Minister say any more about that trial and its evaluation, and whether we are any closer to a definitive test? If not, what guidance is available to medical practitioners for the PSA test?

--- Later in debate ---

[Baroness Merron (Lab)]

The advice and guidance is that GPs should counsel asymptomatic men about the potential benefits and harms of PSA testing, so that they can make an informed decision. However, the guidance is that GPs should not proactively offer a PSA test, for the reasons that we have covered. That is why we are investing in this trial, to find a better test so that we can address this. This is a complex area, as often it is, but we are making progress, as I have already outlined.

[Lord Brennan of Canton (Lab)]

My Lords, it is very welcome that new diagnostic tests are being investigated. However, can we be careful not to give out the wrong message? I was diagnosed with prostate cancer—and I was completely symptomless—thanks to the PSA test. In giving out that message, can we make it clear that GPs should not stop men getting a PSA test, even when they are symptomless, if they are at the right age and in the right bracket?

[Baroness Merron (Lab)]

I certainly agree with my noble friend. As he knows from his experience, tests are available. The point is that they should be used in the right situation. As he knows, one of the issues is people being asymptomatic, which is why it is very important that men take note of their health and report any change or concerns that they have.

[Lord Grayling (Con)]

My Lords, I am also here thanks to early diagnosis. I understand what the Minister is saying about the PSA test, but very many people are here today because they had such a test. It worries me that the message is that, because it is not reliable, it should not be at the forefront. I ask the Minister not to rule out using PSA tests more widely. If it is the best we have got, it may be the only thing we have got.

[Baroness Merron (Lab)]

I thank the noble Lord for sharing his personal experience. I am not suggesting that the PSA test should not be used, but we are talking about extending it and using it in a screening program. I thank him for giving me the opportunity to reassure your Lordships’ House that that is why we have the trial, which will report later this year, to find a better answer; the answer we have currently is not where we need it to be. Yes, there is a role for it, but we must strive for better than we have got currently.

[Lord Sentamu (CB)]

My Lords, 13 years ago, a PSA test saved my life. I had an operation in Leeds hospital and I now have no sign of that, and every year they test me by the same method. I encourage the Minister not to give mixed messages. We need a very clear message that, at the moment, the PSA test saves a lot of lives.

[Baroness Merron (Lab)]

I agree about the need for clear messages, and I hope the noble and right reverend Lord will agree on the need for striving to do rather better.

[Lord Bailey of Paddington (Con)]

My Lords, in many deprived communities, and in the black community in particular, there is a very high incidence of prostate cancer. Before they get to the PSA test, what work is being done to educate communities even to be involved with seeking out that test in order to protect their health?

[Baroness Merron (Lab)]

The noble Lord is quite right to raise this. I am glad to say that the TRANSFORM trial I referred to will help to address this by ensuring that a significant proportion of participants are black men, who suffer disproportionately in this regard. That is really important, because previous trials have not included enough black men. The trial will address those disparities, and therefore the results that we get from that will be really important. It is always the case that working with specific communities to get the right message out is key to what we do.

Musculoskeletal Health: Chiropractors

Baroness Merron Excerpts

Wednesday 26th February 2025 Lords Chamber

[Baroness Ritchie of Downpatrick]

To ask His Majesty’s Government whether they plan to incorporate a role for chiropractors in national musculoskeletal health prevention strategies.

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

My Lords, improving health outcomes for over 17 million people in England with musculoskeletal conditions forms a key part of this Government’s commitment to build an NHS for the future. Healthcare professionals play a vital prevention role in supporting people to self-manage their conditions. NHS England does not commission chiropractic care nationally. However, ICBs have their own clinical or commissioning policies and so may commission a limited amount of such treatment, based on the needs of the local population.

[Baroness Ritchie of Downpatrick (Lab)]

I thank my noble friend for her Answer. I say initially that I am someone who avails periodically of chiropractic services. Will my noble friend the Minister, along with her ministerial colleagues in the Department of Health and Social Care, review the allied health professions list to include chiropractors working within the NHS to deal with musculoskeletal conditions, which in turn could alleviate the burdens on an already overburdened NHS? Could this also be included in the national health plan, which I hope will be published shortly?

[Baroness Merron (Lab)]

I recognise the importance of mitigating the long-term burdens of MSK conditions, which are considerable, and the role that healthcare professionals, including allied healthcare professionals, can play in supporting not just prevention but early detection and the management of conditions. I know that chiropractic care is appreciated in a number of cases, including that of my noble friend. However, clinical evidence from systemic reviews does not support national commissioning of chiropractic treatment, as I mentioned, although ICBs can commission these services. To the point on the 10-year plan—a report on that is expected in the spring, as my noble friend referred to—I place on record that I am grateful to the British Chiropractic Association, the Arthritis and Musculoskeletal Alliance, Versus Arthritis and the Royal Osteoporosis Society for ensuring that the voices of the MSK community have been well heard in the consultation.

[Baroness Burt of Solihull (LD)]

My Lords, 30% of GP consultations are for people with musculoskeletal problems. As a previous back sufferer who has made use of chiropractors in the past, I know personally the transformation that chiropractic treatment can achieve. I can afford that treatment, but many NHS patients cannot, so why can chiropractors not practise across the NHS, when waiting lists for treatment on the NHS are causing the loss of over 6 million working days every year?

[Baroness Merron (Lab)]

The noble Baroness is absolutely right to highlight the extent of the impact of MSK conditions not just on individuals but on our economy and our health service. However, to extend my earlier comments, chiropractic care is regarded as being in the category of complementary and alternative medicines. Some treatments have an evidence base that is not recognised by the majority of independent scientists, whereas others have been proven to work for a limited number of conditions. I appreciate the point that the noble Baroness is making, but probably the simplest way I would wrap it up is in talking of sufficient and reliable evidence, because that is what NHS commissioning at a national level is based upon.

[Lord Lexden (Con)]

My Lords, is it not the case that chiropractic treatment is included in the World Health Organization’s guidance on MSK conditions? Will the Government keep that guidance clearly in mind as they work, as I am sure they will be working, to develop a better approach to helping people with these painful conditions?

[Baroness Merron (Lab)]

I am glad that the noble Lord acknowledges the ongoing work, because we are indeed exploring how best to support dealing with MSK conditions—not least to encourage and provide greater parity in the support that is given. That will be alongside the 10-year plan and the long-term workforce plan. Of course, we keep all evidence continually under review.

[Baroness Winterton of Doncaster (Lab)]

My Lords, I take the point my noble friend the Minister makes about national commissioning and the ability of integrated care boards to do some commissioning, but would not the answer be for the integrated care boards to get all preventative healthcare practitioners to sit down together and work out local strategies? It may well be that one condition can have an effect on another, and perhaps that would make the commissioning of chiropractors easier and fit in with a local preventative healthcare strategy.

[Baroness Merron (Lab)]

My noble friend helpfully emphasises the point about the need to provide for local populations, and ICBs are in the pole position to do that. I am sure that noble Lords will recall that we recently announced changes in the NHS operating model to move power from the centre to local leaders. I particularly refer to the NHS planning guidance, whereby we follow the recommendations of the noble Lord, Lord Darzi, to take a whole new approach and reduce the number of national targets from 32 to 18. The reason for that is to give the local systems my noble friend refers to greater control and flexibility on how local funding is deployed. Indeed, one such model could be the one my noble friend referred to.

[Lord Rogan (UUP)]

My Lords, an estimated 30% of the population of the UK are burdened with a painful and debilitating MSK condition. That is over 20 million people in the United Kingdom. Given the Government’s priority of shifting treatment into communities in the 10-year health plan, will the Minister meet again with representatives from the chiropractic profession to hear how they can increase capacity for community MSK treatments?

[Baroness Merron (Lab)]

I am certainly happy to have such discussions. Perhaps I could use this opportunity to say to noble Lords that part of the recently published elective reform plan sets out funding to boost bone density scanning—or DEXA—capacity, to provide an estimated 29,000 extra scans per year. The work goes on also to support workforce health. For example, we are commencing training so that over 200 doctors and nurses can undertake occupational health training and qualifications. The numbers of physios and OTs are increasing. This is very much work in progress. I certainly agree with what the noble Lord said about the impact and extent of this; it really does affect so many.

[The Lord Bishop of London]

My Lords, according to the Arthritis and Musculoskeletal Alliance report on health inequalities and deprivation, an important way to reduce health inequalities in these conditions, particularly in those groups of people who are underserved, is to help them to manage their own conditions. Often it is much harder because they often have more than one complex condition; often they are much more complex and are picked up much later. One of the recommendations was around moving NHS care into the community. Could the Minister tell us what the Government are doing to encourage the NHS to build partnerships with community groups, including faith groups, to seek to reduce inequalities in these conditions and communities?

[Baroness Merron (Lab)]

Working with community-based organisations, including faith communities, has come up a number of times in the 10-year plan consultation, as I am sure the right reverend Prelate will find. I would certainly associate myself with the comments about the importance of getting healthcare provided in the community.

[Lord Kamall (Con)]

I thank the Minister for giving me the time to ask a question. Following the tragic death of Joanna Kowalczyk in October 2021, the coroner has recently raised concerns over the fact that chiropractors are not required to request their patients’ medical records before they begin treatment. While I recognise that there is scepticism from many in the NHS, and in fact physiotherapists, towards osteopaths and chiropractors, will the Government take on board the recommendations of the coroner to look at changing guidance to ensure that all healthcare treatments require consideration of a patient’s medical history, especially as we move toward a digital single patient record that could be shared across our system of health and care?

[Baroness Merron (Lab)]

The noble Lord raises an important point about what is required before healthcare is provided. I can certainly assure the noble Lord that, as I know he is aware, where there is a coroner’s report, we look at all of the lessons to be learned to consider how we might make it a safer and more effective environment for people. Certainly in the case to which he refers, that will happen.

Mental Health Bill [HL]

Baroness Merron Excerpts

Committee stage
Monday 24th February 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, I thank the noble Baroness, Lady Tyler, for introducing this amendment. It is quite clear that noble Lords across the Committee agree with the Government’s commitment to move the emphasis from sickness to prevention. This amendment is clearly aimed at that, as the noble Baroness has said.

During my time as a Health Minister and since, I have met a number of community and civil society projects, charities and mental health professionals who have shared the amazing work being done across the country to improve the well-being of local communities. I put on record my thanks to the late Baroness Greengross and the noble Lord, Lord Howarth, for introducing me to the wonderful world of creative health and to the National Centre for Creative Health. Its work addresses the theme of earlier amendments from the noble Baroness, Lady Hollins, and the noble Lord, Lord Crisp, on the overprescribing of antidepressants and looking at alternatives. We are not saying that medication is a bad thing necessarily. It is very appropriate in some cases, but there are alternatives, such as social prescribing.

The late Lady Greengross introduced me to a wonderful organisation called Intergenerational Music Making, and I put on record my thanks for its work. It invited me to take part in one of its intergenerational music hubs in Guildford last December and, despite being handed a guitar to play along, I found it inspiring to see the difference that music can make in improving well-being and bringing people of all ages together, including some children from a local learning disability charity.

Noble Lords will also know of the equally amazing work done by many social prescribing organisations, using music, art, drama and green spaces. A career in creative health also opens up new opportunities for budding actors and rock stars who can train as drama and music therapists while waiting for their big break. But many do not wish to be stars and actually find their work, combining their passion with improving mental well-being, fulfilling in its own right.

However, one criticism I hear is that, although there is amazing work on well-being in different primary care settings or in different trusts and integrated care systems across the country, the challenge is how we spread the best practice across our system of health and care, while recognising that what works in one area may not always be an off-the-shelf solution in another locality.

The amendment from the noble Baroness, Lady Tyler —which says that

“Local authorities and commissioning bodies must publish an annual report outlining the steps taken to discharge their duty”


to promote mental health and well-being—may be a way to address this concern. Given that, I hope it is an amendment that the Government will consider. If not, perhaps the Minister can tell your Lordships how the Government intend to encourage the sharing of best practice in improving mental well-being across our system of health and care, particularly across different communities with different needs and different constraints, in order to improve the mental well-being of the nation.

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

My Lords, I thank the noble Baroness, Lady Tyler, for tabling Amendment 160B. We recognise the importance of local organisations taking collective action to promote mental well-being and prevent mental ill-health. However, turning to the amendment very specifically, we do not feel that this amendment suggests the best approach, as there is potential for introducing unnecessary burdens on local authorities and commissioning bodies. It may also be duplicative of other existing duties, such as the Care Act duty, to promote individual well-being.

However, the noble Baroness, Lady Tyler, and the noble Lord, Lord Kamall—whom I also thank for his contribution—may be interested to note that the existing prevention concordat for better mental health, a voluntary agreement signed by local authorities and integrated care boards across the country, does involve, for those who sign it, a commitment to take

“evidence based preventive and promotional action to support”

population mental health and well-being.

Through the NHS 10-year plan, which the noble Baroness referred to, and as noble Lords are aware, we aim to encourage stronger partnership working between local government mental health services and the voluntary and community sector—which, as we know, plays a vital role, as the noble Lord, Lord Kamall, described—in order to galvanise that shift, which we all seek, from sickness to prevention. On the basis of the reasons outlined, I hope the noble Baroness will withdraw her amendment.

[Baroness Tyler of Enfield (LD)]

I thank the Minister for her remarks and the noble Lord, Lord Kamall, for his. I am interested to hear about the prevention concordat and hope to hear more about that; I think that could be a useful way forward. Overall, I remain of the view that having something about prevention in this Bill—we have not got it yet—sends out an incredibly important signal.

I am very happy to accept that the way it is currently worded may not be the best and that we could find other ways of doing it. But I would be really disappointed if, in the final piece of legislation, we do not, in some way or another, have something that underlines the importance of prevention. I am not going to go over all the arguments again. I can see us returning to this on Report and, on that basis, I withdraw my amendment.

--- Later in debate ---

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I was pleased to see these amendments as well. The noble Earl, Lord Howe, explained why they are important. He has conceded—I tried to imply the same in my own amendment—that it is not necessarily clear how best to raise these issues, but that we need to. If we are seen by the public discussing a mental health Bill, going through the whole thing and refusing to acknowledge one of the big controversies of recent times, which was a mental health issue, it will discredit the Bill when it becomes an Act.

In relation to the reluctance of the NHS trust to publish its investigation and the use of patient confidentiality, I note that the families of the victims saw this very much as an excuse and were very angry about that. It does not help us to have a discussion with the public about mental illness because it then seems as though murder was committed but, somehow, mental illness was used as an excuse. We have all heard that argument being used; that is why I referred to the fact that there was some dispute about whether Calocane should be sent to prison or to hospital. The more openness that we can give this, the less stigma and confusion there will be. We need to have this debate out in the open.

Finally, I have a question on the judge-led inquiry and what we now know from the investigation by the trust. How will that impact this Bill? How, practically, will we be able to incorporate what we have learned from that into our discussion on a whole new piece of legislation on mental health? It would seem that we need to be able to take on board some of the recommendations of the inquiry and what we now know from the investigation by the trust.

[Baroness Merron (Lab)]

My Lords, I thank the noble Earl, Lord Howe, for tabling Amendments 160BA and 160BB, supported by the noble Lord, Lord Kamall, and spoken to by the noble Baronesses, Lady Tyler and Lady Fox.

I say at the outset that I understand the deep concerns raised today by noble Lords. I would like to take this opportunity to express my sincere condolences, and I am sure those of the whole of your Lordships’ House, to the families of Grace O’Malley-Kumar, Barnaby Webber and Ian Coates. The Secretary of State and I have met the bereaved families following these horrific killings, and, rightly, important actions have been taken, which the noble Earl, Lord Howe, asked about. Indeed, we have to look at what improvements must be made, both at the trust and across the country.

To take this further, NHS England and the Nottinghamshire Healthcare NHS Foundation Trust have accepted all of the recommendations made following the Section 48 CQC review into this incident, and action has started on implementation. The recently published independent investigation into the care and treatment provided to Valdo Calocane makes a series of recommendations, which NHS England and the Nottinghamshire Healthcare NHS Foundation Trust have accepted. I reiterate that the Government expect to see swift action to ensure that the recommendations are implemented as soon as possible. As the Prime Minister has confirmed, and as the noble Earl, Lord Howe, acknowledged, there will be a judge-led, statutory public inquiry into this tragic incident.

I now turn specifically to the amendments, and first to Amendment 160BA. We recognise the importance of transparency when there are concerns around a patient’s care, to enable a full understanding of what went wrong and how learning can be applied as a result. The courts already have legal powers to request, and where appropriate compel, disclosure of relevant reports, ensuring judicial access to relevant information. In criminal and civil proceedings, courts can make orders that particular information be provided, or issue witness summonses, while coroners can obtain documents as part of an inquest. There is no clear evidence that courts face systemic barriers in accessing necessary information.

There are also existing mechanisms to provide robust oversight and transparency. NHS England’s patient safety incident response framework sets out clear guidelines for responding to serious incidents involving patients who are detained under the Mental Health Act. Additional scrutiny is provided through investigations by the Health Services Safety Investigations Body and oversight from the CQC.

If information is not disclosed, interested parties already have mechanisms to access information, including judicial review, freedom of information requests and the coronial process for deaths in detention. While courts have the powers set out in the amendment, we absolutely recognise the importance of openness in mental health services, which is why officials are working with NHS England to ensure that information from investigations is as transparent as possible—something that all noble Lords have rightly referred to.

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[Earl Howe (Con)]

My Lords, I will keep this brief since I can do no more than back the noble Baroness, Lady Tyler, in every word that she has said in support of these two amendments. We are dealing here with a Henry VIII clause that is surely far too permissive given the great sensitivity of the Bill’s entire subject matter and, as the noble Baroness said so well, its momentous significance for the health and well-being of very vulnerable people.

The absolute minimum that Parliament can expect is that Parliament be consulted in the exercise of these powers. The affirmative procedure is therefore entirely appropriate for any statutory instruments made under this clause and I hope the Minister will not disagree with what is proposed.

[Baroness Merron (Lab)]

My Lords, I thank the noble Lord, Lord Scriven, for tabling Amendments 160C and 160D, which were introduced by the noble Baroness, Lady Tyler, and spoken to by the noble Earl, Lord Howe.

The proposal in the amendment, as was referred to, was a recommendation in the report from the Delegated Powers and Regulatory Reform Committee. I hope that your Lordships’ Committee will welcome that we are actively considering this proposal and will publish our response to the committee’s recommendation ahead of Report.

[Baroness Tyler of Enfield (LD)]

My Lords, I very much welcome the statement we have just heard from the Minister. I think it is a good point on which to finish our deliberations tonight and I thank her very much. I also thank the noble Earl, Lord Howe, for his support. I beg leave to withdraw the amendment.

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Moved by

[Baroness Merron]

161: After Clause 51, insert the following new Clause—
“Power of Welsh Ministers to make consequential provision(1) The Welsh Ministers may by regulations made by statutory instrument make provision that is consequential on this Act.(2) The only provision that may be made by virtue of this section is provision that would be within the legislative competence of Senedd Cymru if contained in an Act of the Senedd.(3) Regulations under this section may amend, repeal or revoke provision made by or under primary legislation passed—(a) before this Act, or(b) later in the same session of Parliament as this Act.(4) In this section “primary legislation” means—(a) an Act, or(b) an Act or Measure of Senedd Cymru.(5) A statutory instrument containing regulations under this section is subject to annulment in pursuance of a resolution of Senedd Cymru.” Member's explanatory statement
This confers a regulation-making power on the Welsh Ministers to make consequential provision that is within devolved legislative competence. The Secretary of State has an equivalent power under Clause 51.

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Moved by

[Baroness Merron]

162: Clause 53, page 64, line 2, leave out “33, 34,” and insert “29(2), 31, 33, 34(1) and (3)(b),”
29(2)
34(1)
(3)(b)
Member's explanatory statement
This amendment would provide for certain provisions currently commenced by regulations to be commenced two months after Royal Assent (and vice versa).

Mental Health Bill [HL]

Baroness Merron Excerpts

Committee stage
Monday 24th February 2025 Lords Chamber

[Earl Howe (Con)]

My Lords, I am right behind the noble Lord, Lord Scriven, and the noble Baroness, Lady Tyler, in their Amendment 130. We know, and I believe that by and large we accept, that the Bill is not intended by the Government to hold out the prospect of instantaneous changes to the delivery of mental health care. It offers a series of measures that, over a period of years, should make a material difference to the well-being of a wide range of mentally ill people who require treatment, whether in a secure mental health setting or in the community.

The Minister has spoken of the need to view these measures in the broader context of the NHS 10-year plan and, certainly from the Government’s point of view, that is a perfectly reasonable position to take. However, if that is the Government’s policy, it begs a whole mass of questions around implementation and funding. For example, what do the Government see as the immediate high-priority measures that they wish to introduce? Which measures do they propose to defer, and for how long? What are the costs associated with these changes, both to the NHS and, as the noble Baroness, Lady Tyler, pointed out, to the justice system and local government? Bearing in mind Treasury constraints, when realistically do they believe a clear timeline for change will emerge? We have the impact assessment, but how far can we rely on that?

If those questions for the time being have to remain hanging in the air, as I suspect they will, I share the view of the noble Baroness, Lady Tyler, that Parliament, in the not-too-distant future, needs to be given an account of what the longer-term future looks like in a way that reflects not only the Government’s current thinking but, as time goes on, how their thinking evolves, as it surely will. There is therefore a strong case for a report to Parliament sometime in the next few months and on an annual basis thereafter, making clear both the timeline of ambition and the timeline of what in reality is being delivered.

I am conscious that we all need to keep our remarks succinct and to the point, so I will comment only briefly on the other amendments in this group. I am afraid I cannot support Amendment 153 in the name of the noble Baroness, Lady Bennett. I have always believed that what matters most in healthcare is not whether a service is delivered by a public or a private organisation but rather the quality of care to patients and whether good outcomes are achieved at acceptable cost.

Finally, my noble friend Lord Kamall has added his name to Amendments 163 and 164. These amendments stand absolutely four-square with the theme of Amendment 130, and on my noble friend’s behalf I express my warm support for them. The noble Lord, Lord Stevens, has said it all.

Just as we accept that we will not get any instant changes arising from the Bill, by a corresponding token, the Government cannot take that as a free pass from Parliament to defer implementing its provisions sine die. We cannot have a situation in which, prior to implementing the provisions, the principle of parity of esteem is quietly put to one side. I hope the Minister will have reassuring words to say on those very important points of principle.

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

My Lords, I am most grateful to noble Lords for their contributions to this first debate today, and I start by saying how glad I am—I am sure other noble Lords will say this too—to see the noble Baroness, Lady Hollins, in her rightful place. I certainly heard her support for the amendments that we are discussing.

Before I turn to the amendments, it may be helpful to your Lordships’ Committee if I briefly set out some of the high-level plans for implementation of these reforms. I am grateful for the understanding—the noble Earl, Lord Howe, made this point—that time is required. I also understand the emphasis that noble Lords are putting on pace and, of course, we try to match those two things together, but I know we are all agreed on the need to get the Bill in the right place and the Act delivering.

The first priority after Royal Assent will be to draft and consult on the code of practice, and we will be engaging with people with lived experience and their families and carers, staff and professional groups, commissioners, providers and others to do this. The code will be laid before Parliament before final publication, and I am committed to working with noble Lords to ensure that we get this crucial piece of work absolutely right. We expect that this process will take at least a year.

Alongside the code, we will be developing secondary legislation, which will also be laid before Parliament, with more detail on areas such as statutory care and treatment plans. We will then need time to train the existing workforce on the new Act, the regulations and the code. This will likely be in 2026 and 2027, and we intend to commence the first major phase of reforms in 2027.

Of course, some reforms are going to take longer, as noble Lords will appreciate. The noble Baroness, Lady Neuberger, tempted me to go even further than five years, and I thank her for the temptation, but I know I will not be able to please her on this occasion. Of course, it takes time to train new second opinion appointed doctors, judges and approved clinicians, so, as set out in the impact assessment, we believe it will take 10 years to fully implement the reforms, but I emphasise that these timelines are indicative, and we will iterate these plans as we get more certainty on future funding and the wider workforce plans. Of course, I fully appreciate the importance of parliamentary scrutiny and accountability of this work, which is crucial, and I am committed to updating the House throughout the implementation period.

Turning to the amendments, I will start with Amendment 130 in the name of the noble Lord, Lord Scriven, kindly introduced by the noble Baroness, Lady Tyler. I say in response that any implementation plan, as proposed in the amendment, which would be published four months after Royal Assent, would be very unlikely to contain any more detail than is already in the impact assessment. It is important to prioritise drafting the new code and the secondary regulations after Royal Assent. I also confirm to your Lordships’ Committee that we will commission an independent evaluation of the reforms, alongside existing monitoring and reporting by the CQC.

As I have said, I fully expect to update the House during the planning and delivery of the reforms. However, a requirement in primary legislation to publish annually, and within four months of Royal Assent, would be premature.

Amendment 153, tabled by the noble Baroness, Lady Bennett, would prohibit for-profit companies from delivering provisions of the Act. I listened closely to the concerns raised by the noble Baroness, but I do not share the view that a ban on for-profit providers is the right approach, for the reasons that were set out by the noble Earl, Lord Howe, and the noble Baroness, Lady Fox. Our focus should indeed be on ensuring that we have high-quality and good value-for-money services. However, I assure the noble Baroness, Lady Bennett, that we are already investing in a significant quality transformation programme and piloting new models of care to ensure that care is focused on the individual, with maximum therapeutic benefit. That is where our priority lies and for that reason we are resisting this amendment.

Turning to Amendment 163, I am grateful to the noble Lords, Lord Stevens and Lord Kamall, and the noble Baronesses, Lady Tyler and Lady Neuberger, for bringing this issue before the Committee. As I said in my opening remarks, I too want to see the benefits of these reforms coming into play quickly and effectively. We intend to commence the reforms in phases, because some can be implemented more quickly than others, which need more time. This is not just about money but about building system and workforce capacity. For example, the impact assessment estimates that we need over 400 additional second opinion appointed doctors and over 300 additional approved clinicians. Many of these will be consultant psychiatrists, who would already need to have commenced training prior to the legislation for us to fully implement the Bill within five years, as required by this amendment. Rather than having a fixed deadline, as is proposed, we intend to monitor the impact of investment and test readiness to commence new powers on an ongoing basis, commencing each phase when we are confident that it is safe and effective to do so.

Finally, I turn to Amendment 164, tabled by the noble Lord, Lord Stevens, and supported by the noble Lord, Lord Kamall, and the noble Baronesses, Lady Tyler of Enfield and Lady Neuberger. I associate myself with the comments about the commitment to treating physical and mental health equally, in line with this Government’s manifesto commitments. The mental health investment standard requires ICB spending on mental health to grow at least in line with overall recurrent funding allocations. Based on total planned spend for 2024-25, we expect all ICBs to meet the standard in this financial year.

There are already mechanisms to ensure that spending on mental health is prioritised. I refer noble Lords to Section 12F of the NHS Act 2006, which requires the Secretary of State for Health and Social Care to lay before Parliament an annual document setting out whether they expect NHS England and ICB spending on mental health to increase in the next year. The Secretary of State will publish this statement before the end of this financial year.

As several noble Lords said, funding for mental health spend goes beyond the scope of the Mental Health Act, which aims to improve the care and treatment of individuals who have a mental illness and need to be detained in hospital or subject to restrictions in the community. Therefore, I respectfully suggest that the Act is not the appropriate mechanism for holding the Government to account on mental health spend. I ask the noble Baroness to withdraw the amendment.

[Baroness Tyler of Enfield (LD)]

My Lords, I thank the Minister for her very comprehensive response and all noble Lords who have spoken. It was very helpful that the Minister started by setting out some of what I think she called the “high-level” plans for implementation. It was good to hear about what is going to happen with the code of practice and about plans to bring forward secondary legislation. I hope I heard correctly that it will be 2027 when we see the first major stage of these reforms starting to happen on the ground. That is the good side of this debate; it is incredibly important, because this is one of those issues where the implementation is as important as the policy, and that is why it is right that we are having this discussion.

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[Lord Kamall (Con)]

My Lords, before I begin my remarks, I want to say how pleased my noble friend Lord Howe and I are to see the noble Baroness, Lady Hollins, back in her place; I am sure that many noble Lords would echo that sentiment.

I thank the noble Baroness, Lady Tyler of Enfield, for moving this amendment to establish a statutory mental health commissioner. One of the motivations behind some of the amendments in my name and that of my noble friend Lord Howe is to probe the Government on those recommendations from the pre-legislative Joint Committee that did not make it into this draft Bill. As noble Lords will be aware, and as the noble Lord, Lord Bradley, has said, this is one such recommendation of the Joint Committee that did not make the cut.

We did consider tabling a similar amendment ourselves, but I have to admit that the amendment from the noble Baroness, Lady Tyler, did the job very well; there was no need to duplicate that. Having spoken to the noble Baroness and to her noble friend Lord Scriven, I know this is an issue that they and many other noble Lords feel passionate about. The noble Baroness, Lady Tyler, has today made a very good case for a commissioner. The noble Lord, Lord Scriven, has also spoken of the need for central co-ordination to ensure implementation of the provisions of this Bill—something that was referred to in the last group of amendments.

I pay tribute to the noble Lord as I know that he has considerable experience in the NHS and is all too aware of the problems involved in trying to deliver at scale. However, I admit that I have some reservations about the idea of a mental health commissioner. While I understand the arguments in favour, I am, like the Minister, concerned about the creation of a new bureaucracy that could possibly duplicate functions.

In their response to the recommendations of the Joint Committee, the previous Government noted that

“the government does not believe that a statutory mental health commissioner would add significant value within the framework currently provided by existing bodies”.

The Joint Committee pointed out that a Mental Health Act Commission was established by the Mental Health Act 1983, which stood alongside the Healthcare Commission and the Commission for Social Care Inspection. In 2009, the then Labour Government took the decision to combine these three bodies into one integrated regulator with responsibility for all health and adult social care. I say that not as a political point but as an observation.

Since then, the CQC has undertaken the functions of the previous Mental Health Act Commission, and its remit extends to ensuring protections for those who are detained under the Act or subject to a community treatment order. To do this, the CQC has a number of Mental Health Act reviewers, who can visit patients in hospital and raise concerns about treatment or detention with managers, and then report back to the commission. The CQC also has a dedicated team that assesses complaints about the use of the Mental Health Act, including issues around detention and the use of CTOs.

I also understand that the CQC provides second-opinion appointed doctors for patients who do not have the capacity to consent to treatment under Part 4 of the Act. This Bill strengthens the safeguards around second-opinion appointed doctors, such as creating a clinical checklist that must be certified by the second-opinion doctor.

In addition to the functions of the CQC, local authorities and ICBs provide independent mental health advocates; we have debated those in earlier groups. The Department of Health and Social Care also gives funding to local authorities to commission Healthwatch services, of which I understand there are about 152 across the country. Healthwatch is another statutory organisation that gathers feedback from the users and ensures that NHS leaders listen to and, hopefully, incorporate that feedback.

As we have seen, the Parliamentary and Health Service Ombudsman, alongside the CQC, supports individuals to raise complaints against the private sector, the NHS and all public health authorities.

The point I am trying to make is that there appears to be a plethora of services and public bodies that work to oversee the function of the Mental Health Act and try to ensure that patients have a voice in their care and treatment. While I appreciate that some of the proposed duties of the commissioner would be unique to that role, there appear to be elements of duplication in that role and those of existing public bodies. However, I am also conscious of the point made by the noble Baroness, Lady Tyler, about being complementary.

So, while I hear the arguments on both sides, I am still slightly sceptical about whether we need a stand-alone mental health commissioner. To be fair, we have not completely made up our minds yet, and my noble friend Lord Howe and I are weighing up the arguments. For that reason, I ask the Minister to help these deliberations by clarifying a few points. First, will she confirm whether the CQC will take on the role of implementing the provisions of the Bill? Perhaps more importantly, how will it be able to fulfil that function effectively, given the concerns expressed by the noble Baroness, Lady Tyler, the noble Lord, Lord Bradley, and others and their strong feeling in favour of an independent mental health commissioner?

What action will the Department of Health and Social Care take to ensure oversight of the CQC’s role in the implementation of this legislation? If the Government remain opposed to the creation of a commissioner, can the Minister reassure your Lordships on how existing bodies will address the Bill’s implementation and accountability for its implementation, without the need for a stand-alone mental health commissioner?

I hope the Minister is able to give these assurances. Otherwise, given what was said today by other noble Lords, I am sure we will come back to this issue on Report.

[Baroness Merron (Lab)]

My Lords, I am grateful to the noble Baroness, Lady Tyler, for tabling Amendment 131, supported by the noble Baronesses, Lady Bennett and Lady Murphy, and my noble friend Lord Bradley. As noble Lords are aware, I understand the intent behind the amendment. We have carefully considered the proposed functions of the commissioner that it outlines, and we recognise that improvements are needed to ensure that the system works effectively. But as noble Lords are aware, we do not feel that a new body is the answer. As the noble Lord, Lord Kamall, said, it may only duplicate existing functions, rather than providing the clarity and leadership that I know everyone is seeking. I was particularly interested to hear the noble Lord give his reflections on the opinions of the previous Government about a proposed mental health commissioner.

Overseeing implementation of the reforms is the role of the Department of Health and Social Care, working with NHS England, the Ministry of Justice and the CQC in England, and, in Wales, with the Healthcare Inspectorate Wales.

On the interaction between this legislation and the Mental Capacity Act, we are committed to keeping that under close review to minimise challenges potentially faced by front-line professionals.

The annual report by the commissioner proposed in the amendment would overlap with the CQC’s annual Monitoring the Mental Health Act report. The CQC’s annual statutory reporting reflects the views of thousands of patients interviewed each year by the CQC. Many of the issues that the commissioner would assess and report on, such as the accessibility of advice and the quality of services, are already reported on by the CQC.

It is proposed that the commissioner would examine cases of people detained under the Act. This clearly overlaps with the functions of the CQC and Healthcare Inspectorate Wales, which have a statutory duty to monitor and, where appropriate, to investigate. The Act provides the regulator with similar powers—for example, to gather information to support it in exercising these powers.

The Health Services Safety Investigations Body is responsible for conducting independent investigations into patient safety concerns across England to identify ways to improve mental health care and patient safety. It has just concluded a series of investigations into in-patient mental health care and is currently undertaking further work.

With regard to the proposed commissioner’s general powers, it is the Government’s role, with NHS England, to ensure sufficient capacity and resources in the system. It is the role of NHSE’s national director for mental health and the medical director for mental health and neurodiversity, newly established last year, to oversee and take forward improvements to mental health services. It is already the role of the regulator to safeguard the rights and welfare of patients, while other organisations independently investigate complaints.

Minimising duplication with these organisations and functions would require significant remodelling of the system, interrupting ongoing programmes and responsibilities that are important to the smooth delivery of the Mental Health Act reforms. Having said that, we recognise that improvements need to be made in the quality of care and the patient safety landscape. We are committed to that goal and intend to overhaul the healthcare system to make it better for all patients.

The CQC has already begun to implement the recommendations made by Dr Penny Dash and Professor Sir Mike Richards: a new chief inspector for mental health will use their independent voice to amplify and respond to the experiences and outcomes of people who use services. Implementation of Mental Health Act reform will be at the top of their “to do” list.

On the wider landscape, we expect to hear soon from Dr Dash who, as noble Lords have said, is reviewing the broad range of organisations that impact on quality and safety, many of which I have mentioned today, and is due to report on whether greater value could be achieved through a different delivery model.

Reference was made in the debate to the role of the Children’s Commissioner, which the noble Baroness, Lady Tyler, particularly focused on. I want to place on record my gratitude to the Children’s Commissioner for the work done on children’s mental health. But, in reflecting on the debate earlier, I should say that the Children’s Commissioner is operating in a rather difference landscape. The proposed mental health commissioner would have a much narrower purview that, for the reasons I have stated, risks overlapping with existing organisations in a way that the Children’s Commissioner does not. I understand why the Children’s Commissioner is being looked to, but I cannot draw that direct comparison myself.

The challenges we have heard about in this debate have highlighted areas we need further to focus our efforts on. I look forward to speaking to the noble Baroness, Lady Tyler, about this topic this week, and I am sure that I will have further conversations about it. For all these reasons, I ask the noble Baroness to withdraw Amendment 131.

[Baroness Tyler of Enfield (LD)]

My Lords, I thank the Minister for her response and thank other noble Lords for their support: in some cases, strong support; in others, what I can only describe as support up to a point—if you know what I mean.

The noble Lord, Lord Kamall, was right to say that we on these Benches feel passionate about this. We think it has the potential to make a real difference and transform not just mental health services at the crisis end—the detention end—but how the whole mental health landscape works.

I would just say in response that I am slightly surprised that the Government consider the current arrangements to be satisfactory. The Joint Committee clearly did not. It spent an awful lot of time looking into this and made a recommendation for a reason.

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[Lord Kamall (Con)]

My Lords, I thank the noble Baroness, Lady Parminter, for moving this amendment. Unlike in the last group of amendments, where there was limited support, we fully support her on this one. We know that the noble Baroness has tirelessly campaigned for better support for those with eating disorders. At Second Reading, she shared the experience of living with such disorders, and we all became much more familiar with some of the concerns. I also agree with my noble friend Lady Browning that it is about time we stopped treating all people with mental ill-health the same; we know that we have to look at it in far more granular detail.

The amendment speaks to the problems around the adequacy of provision of care for patients suffering with eating disorders. As the noble Baroness said, Section 140 of the Mental Health Act provides for reception of patients in cases of special emergency and the provision of accommodation and facilities suitable for under-18s, but it applies only to hospitals. I agree that there is a reasonable case to extend this to specialist eating disorder units. With that in mind, I hope the Minister will be receptive to this amendment.

[Baroness Merron (Lab)]

My Lords, I am grateful to the noble Baroness, Lady Parminter, for bringing Amendment 132 to your Lordships’ Committee, for raising this important issue, for sharing at Second Reading, as the noble Lord, Lord Kamall, said, her personal experience of her daughter’s treatment and for sharing her overall experience of the provision of services today. The noble Baroness, Lady Browning, made the important point about different conditions needing different provision and support. That was amplified by the noble and learned Baroness, Lady Butler-Sloss, and the noble Lord.

Eating disorders are of course serious mental health challenges, and it is vital that those with them can access effective help quickly. We will continue to work closely with NHS England to improve access to the right and timely care and treatment for those with an eating disorder.

The purpose of Section 140 is to ensure that approved mental health professionals are aware of the services available to help them to locate hospital beds in special cases. The intention of the amendment is to extend the duty on health authorities to notify local authorities of arrangements for urgent cases and under-18s to include specialist eating disorder units.

Section 140 applies to arrangements for people who need in-patient treatment in a hospital. That includes specialist eating disorder units where they provide in-patient treatment in a hospital setting and are appropriate for someone to be detained in. Therefore, while I understand the points being made, it is not necessary to specify that Section 140 applies to specialist eating disorder units. I hope the noble Baroness will feel able to withdraw her amendment.

[Baroness Parminter (LD)]

My Lords, I am grateful to Members around the Committee who have shared my concerns about the need for proper provision for people with eating disorders. The noble Baroness, Lady Browning, rightly identified that there is a need for mental health provision to focus on the particular illnesses and to treat each appropriately.

I knew that my amendment would not be accepted; I was just desperate to find some way to raise this important issue, but I am grateful that my poor attempt has at least allowed for a debate in Committee and allowed me to share with Members a bit more about what it actually means if you are in a specialist eating disorder unit for a very long time. I would still love to see the words in the Bill, because every time ICBs and others think about provision for people with mental illnesses, including eating disorders, specialist eating disorder units should be in there, but I am not going to press the point either here or in the future. I am grateful for the support around the Committee, and I will keep trying to raise the issue whenever I can. With that, I beg leave to withdraw the amendment.

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[Lord Kamall (Con)]

My Lords, I will be brief on this one. I thank the noble Baroness, Lady Tyler, for this amendment and thank all noble Lords, who made very valid points.

Clearly, this is another sensible proposal, highlighting as it does the importance of making sure that the ICBs commission sufficient mental health services in the community to meet the demand for them. As the noble Baroness, Lady Barker, said, where will people go in the middle of the night? I know that we will come back to some of these issues when we discuss the group on mental well-being but I thought it was important that those points were raised now.

The Committee may remember that this was the subject of Amendment 139 in the name of my noble friend Lord Howe, who spoke to it on the second day in Committee. The main difference between those amendments is, I think, that the noble Baroness, Lady Tyler, wishes to get ICBs focused on this very important task as soon as the Bill becomes law—and I agree with her intention on that. My only fear around the wording as it is currently drafted—I recognise that it is a probing amendment—is that

“insofar as is reasonably practical”

may provide an excuse, or, as we say, the proverbial long grass into which this duty could be conveniently kicked. I look forward to the Minister’s response.

[Baroness Merron (Lab)]

My Lords, I thank noble Lords for their contributions on both these amendments. I turn first to Amendment 134 in the name of the noble Baroness, Lady Tyler, and spoken to by my noble friend Lady Ramsey and the noble Baroness, Lady Barker, both of whom shared real-life examples to illustrate what is being spoken about here.

This duty to consider mental health needs, as well as the needs of those with a learning disability and autistic people, in the community as well as in hospital is already covered by ICBs under the National Health Service Act 2006, as amended by the Health and Care Act 2022. An ICB must arrange for the provision of services to such extent as it considers necessary to meet the reasonable requirements of the people for whom it has responsibility.

ICBs and their mental health trusts are also required to prepare a joint forward plan that describes how the ICB will arrange for NHS services to meet its population’s physical and mental health needs, and the needs of those with a learning disability and autistic people.

On the general point with regard to the long-term workforce plan, which the noble Baroness, Lady Barker, mentioned, it will report in a few months’ time, later in the year, which I hope will give a lot more substance to answer the kinds of questions that are being raised. The noble Lord, Lord Stevens, asked about incremental requirements for psychiatrists on a year-by-year and whole-time-equivalent basis. I say to the noble Lord that the impact assessment sets out our best estimate at this point, but the plans need to be seen as somewhat iterative. With regard to further specific questions, including those raised by the noble Baroness, Lady Tyler, I will indeed be glad to write.

Turning now to Amendment 157, in the name of my noble friend Lord Davies and spoken to by the noble Lady Baroness, Lady Bennett, as we have already discussed in relation to Amendment 134, there is already a duty on ICBs to provide sufficient hospital and community services under the National Health Service Act 2006. Furthermore, chapter 16 of the Mental Health Act code of practice already states that local authorities, NHS commissioners, hospitals, police forces and ambulance services should have local partnership arrangements in place to deal with people experiencing crises in mental health.

We accept that there are issues with bed capacity and patient flow, as referred to by the noble Baroness, Lady Hollins. I will resist using the term “patient pathway”, but I certainly agree that they are part of what happens to a patient and they are indeed linked—whatever form of words we choose to use. That is why, in the recent NHS planning guidance, we have tasked local systems with reducing the length of stay in mental health wards and have committed £26 million to improve mental health crisis care, with a further £75 million to reduce inappropriate out-of-area placement. All this is already in train and does not suggest a requirement for primary legislation. So, for these reasons, I ask that the amendment be withdrawn.

[Baroness Tyler of Enfield (LD)]

My Lords, I thank the Minister yet again for her response. We have had a number of discussions so far this afternoon in this broad area, and indeed, as was alluded to, on previous Committee days. They are interrelated, so it is sometimes hard to separate the individual groups. I think at the very heart of all of our discussions is concern about two things: first, how we ensure that there is sufficient provision within the community to provide the sorts of services we all hope to see and which are fundamental to the successful implementation of the Bill; and, secondly—I think this came out very clearly—the need for really good workforce planning and understanding it on a year-by-year basis.

I was encouraged to hear from the Minister that we can expect to see the long-term workforce plan—I think she said—in a few months’ time. I very much look forward to that. I hope it includes some of the workforce planning and modelling of community provision that my noble friend Lady Barker referred to, and I hope, above all things, that it is slightly clearer than the impact assessment, which, I have to be honest—it may just be me; it might have been late at night when I was looking at it—I found somewhat on the opaque side. I am really hoping for greater clarity when we see the long-term workforce plan. This issue is not going to go away. In what form we return to it at Report, I am not quite sure, but, for the moment, on that basis, I beg leave to withdraw the amendment.

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[Baroness Merron (Lab)]

My Lords, I am grateful to my noble friend Lord Davies of Brixton for raising what is a very real issue, among many we are debating today in Committee. I thank him for Amendment 135, supported by the noble Baronesses, Lady Bennett, Lady Neuberger and Lady Tyler, and spoken to by the noble Baroness, Lady Watkins, and supported by the noble Lord, Lord Kamall. I certainly agree that breathing space can indeed be what could be described as a lifebelt for people in problem debt, especially where this is worsening or is indeed a trigger for their mental illness, as my noble friend Lord Davies spelled out and the noble Lord, Lord Kamall, endorsed.

Individuals who are detained in hospital for assessment or treatment under the Mental Health Act are eligible for this scheme, as are those receiving crisis treatment in the community from a specialist mental health service. Approved mental health professionals can refer eligible individuals to protect them from debt enforcement. These professionals are often the first on the scene when a person is in crisis and are responsible for arranging assessment for treatment under the Act. Therefore, when a person is admitted to hospital, they may already have been enrolled in the scheme and, if not, NHS England guidance sets out the financial support, including referral to breathing space, that should be offered to patients receiving acute in-patient mental health care, whether detained or voluntary. I can say to your Lordships’ Committee that we do intend to make this an explicit requirement in the Mental Health Act code of practice.

I feel that is particularly important as my noble friend Lord Davies raised the point about uptake. Certainly, I recognise that uptake has been lower for the scheme than originally anticipated. While we do not believe this is a representation of the scheme significantly underperforming, I assure my noble friend that we will continue to keep the scheme under review to ensure that it is working effectively for those who need it, and needed indeed it is. It is for these reasons that I hope that my noble friend will withdraw the amendment.

[Lord Davies of Brixton (Lab)]

I thank everyone who has taken part in the debate; the case was made clearly by everyone. I thank particularly the noble Baroness, Lady Watkins, for the additional point about the pressure on clinical staff. This issue was, of course, raised in the earlier amendments about the code of practice and the treatment plan; they are all of a piece. I will consider carefully what my noble friend the Minister said, and perhaps we will have some discussions, and we will see where they go. In the meantime, I beg leave to withdraw my amendment.

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[Lord Berkeley of Knighton (CB)]

My Lords, I am only marginally less shocked than the noble and learned Baroness. The reason for that is that I regularly visited a friend in an adult ward, suffering, funnily enough, from eating disorders, among other things. So I support Amendment 144 most strongly. What shocked me was that, over several years, there were two children I saw. They were witnessing not only acts of violence but sexual acts too that were quite clear—I will not go into the details, but it was completely inappropriate for a child to be witnessing this.

The final point I want to make hinges on what we have also heard: that there is only so much we can do. Of course, the reason for that, and it is another reason why these experiences are seared into my mind, is the state of funding for mental health. No one can turn that switch on immediately, but the root problem here is that this is a sector that is somehow pushed to the side. Therein lies a fundamental reason why we have to take a completely different attitude to mental health, and I am sure that the Minister feels quite strongly about that herself.

[Baroness Merron (Lab)]

My Lords, I will turn first to Amendments 142, 143 and 144, in the name of the noble Earl, Lord Howe, supported by the noble Lord, Lord Kamall, and joined by the noble Baroness, Lady Tyler, on Amendment 143 and 144. I will also address Amendment 159 in the name of the noble Baroness, Lady Berridge.

I thank the noble Earl, Lord Howe, for the way in which he introduced this subject and for the understanding and shock shared by the noble Lord, Lord Berkeley, and the noble and learned Baroness, Lady Butler-Sloss. I am sure we all share the thoughts and views that they have expressed. I also thank the noble Earl, Lord Howe, for his reference to Blooming Change. I certainly recognise the important work that it does. The way he introduced its observations and experience really highlighted the reality of what we are here to deal with.

On Amendment 142, it is crucial that people with physical disabilities have equal access to mental health services. Under the Equality Act 2010, those providing mental health services, including under the Mental Health Act, must make reasonable adjustments to ensure that people with disabilities are not at a disadvantage. Therefore, the aims of this amendment are already covered by existing legislative requirements. I heard what the noble Lord said about an example of where this was not the case. I can only add my own comment to say that this is, of course, not acceptable and not at all how legislation would expect a provider to act.

We will review the guidance on how to support individuals with a physical disability, including children, when we consult on the revised code of practice and as part of NHS England’s new service specification, which will set out requirements for children and young people’s mental health services. I hope that will be helpful to meet the points raised in Amendment 142.

I turn now to Amendments 143, 144 and 159. The policy of NHS England is clear that children and young people should be able to access the right type of service, as close to home as possible and in the least restrictive environment. We do not want to see children and young people on adult wards or placed far from home. We are working to secure the necessary investment to expand community-based support and specialist beds to prevent this from happening. I am grateful to the noble Earl, Lord Howe, for referring to the need to deal with where we are rather than where we might like to be. That is what we intend to do.

There are already provisions in the Act that seek to limit inappropriate placements for children and young people. Under Section 131A, hospital managers must ensure that the patient’s environment is suitable, having regard to their age. We believe that the careful consideration and nuance involved in determining any circumstances where it is in a child’s best interest to be treated on an adult ward or in an out-of-area placement fits better in a revised code of practice rather than legislation, which would apply fixed rules that could not be adapted to individual circumstances or service provision.

We will provide additional guidance on the process to determine, and review throughout a child’s detention and treatment, that the environment in which they are accommodated continues to be in their interests. Such matters can be addressed through the new service specification for specialised children and young people’s mental health services.

I assure the Committee that there are already clear operational processes in place to identify and monitor children and young people in inappropriate placements. It is a statutory requirement for the CQC to be notified within 48 hours if a child or young person is placed on an adult ward. The CQC reports on the number of people under 18 admitted to adult wards as part of its Monitoring the Mental Health Act reports.

The CQC project on improving regulation for children inappropriately placed will identify what CQC can do to prevent children being cared for by providers who cannot meet their needs and to reduce their risks of being exposed to poor-quality care. I assure the Committee that we will review the process for who should be notified, and in what circumstances, in the new service specification for specialised children and young people’s mental health services, and in the revised Mental Health Act code of practice.

I turn to Amendment 160, tabled by the noble Baroness, Lady Berridge, on the extension of Section 17 of the Children Act 1989 to include children detained under the Mental Health Act. Section 17 places a duty on local authorities to provide support for children who are unlikely to reach or maintain a satisfactory level of health or development, or where their health or development would be significantly impaired without the provision of services—or where the child is disabled.

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[Baroness Barker (LD)]

My Lords, we on these Benches offer our support to the noble Baroness, Lady Hollins, for her two very thoughtful amendments and the way in which she introduced them. However, I want to turn our attention to Amendment 146, in the name of the noble Earl, Lord Howe.

I was a colleague of Norman Lamb, who was formerly a Minister in the department. He was one of the people who was, as a Minister, most active in addressing the issue of the overuse of force in mental health. This is a campaign that he has continued to develop in his chairmanship of South London and Maudsley NHS Foundation Trust. It is a subject that I am very glad we are focusing on again.

Anybody who has visited a mental health facility in which there are people who are having acute episodes will know that there are times when, for the safety of the person and the safety of others, it is necessary sometimes to use restraint. However, as I think the noble Earl was alluding to in his introduction, the overuse and frequent use of force is often an indicator of substandard care. Therefore, it is very important that incidences of use of force and the reasons for it, as in his carefully crafted amendment, are recorded.

There are two things that I want to pick up with the noble Earl. His amendment is very carefully crafted. In his introduction to it, he referred throughout to children, but his amendment relates not just to children but to all mental health patients. For that reason, I wish to concentrate on proposed new subsection (9). It says:

“In subsection (4)(k) the ‘relevant characteristics’ in relation to a patient mean—”,

and then lists all of the protected characteristics within the Equality Act, with one omission: gender reassignment. I therefore wish to ask him simply why people undergoing gender reassignment do not merit the same protection as everybody else.

[Baroness Merron (Lab)]

I thank noble Lords for their contributions. Let me first turn to Amendment 146, tabled by the noble Earl, Lord Howe, and supported by the noble Lord, Lord Kamall.

The amendment largely replicate duties under Section 6 of the Mental Health Units (Use of Force) Act 2018 for all patients in NHS mental health units. We recognise that the data suggests that the use of force for children and young people is still far too high, and we are working with NHS England to address this. Although the section I have referred to has not yet been commenced, the guidance is published and the data is already being recorded and reported, and we plan to commence the duty formally later this year. The amendment as drafted would capture a much broader range of patients than the use of force Act does—for example, all patients who are being treated for dementia or delirium in an acute hospital. Furthermore, it is not clear what use will be made of that data. Therefore, the volume of new data collection processes could be significant, but the benefits that would result from this are somewhat unclear.

I turn to Amendments 155 and 156, which have been put forward by the noble Baroness, Lady Hollins, regarding long-term segregation. The amendments are supported by the noble Lord, Lord Crisp, the noble Baroness, Lady Browning, and my noble friend Lady Ramsey, both of whom made important contributions to the debate.

Like other noble Lords, I thank the noble Baroness, Lady Hollins, for her work on this issue over many years, including her significant report, My Heart Breaks, which the noble Baroness, Lady Browning, rightly referenced. We are here today, I believe, in no small part due to the tenacity of the noble Baroness, Lady Hollins, and others who have fought for better outcomes for people under the Mental Health Act. I thank them all.

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[Baroness Hollins (CB)]

There seemed to be an assumption that long-term segregation would continue and that perhaps ICETRs are not effective, but one thing that emerges from an independently chaired review is some learning about the barriers in place and the reasons why LTS is being used, rather than more therapeutic options. That is the reason for this kind of oversight being necessary. It is not necessarily that the ICETR itself will lead to recommendations being implemented; in my report, we found that the recommendations were not being followed—they were made and then not followed through. There needs to be much more effort to try to learn from what is happening and begin to change the culture of LTS as an okay response to somebody’s distress.

[Baroness Merron (Lab)]

I understand that point, and the noble Baroness makes it very well. I simply refer her to the points that I made about needing to look at evidence, the outcomes and the value of those reviews, and whether that is the right approach for everyone. I take on board her point, but my comments probably tell the Committee that we feel that there is more work to be done in this area.

[Earl Howe (Con)]

My Lords, once again, I express my appreciation to all noble Lords who have contributed to this debate. I highlight in particular the speech of the noble Baroness, Lady Hollins, which I found extremely powerful and persuasive, as did other noble Lords.

It strikes me that this is an especially appropriate grouping of amendments. The overuse of restraint in mental health settings and the use of completely untherapeutic long-term segregation are equally pressing and emotive concerns.

The noble Baroness, Lady Barker, pulled me up slightly on the issue of protection for those undergoing gender reassignment. The concern that I had in drafting the amendment was to cover protected characteristics across the piece, but she has drawn my attention to a lacuna, and I am very grateful.

I was somewhat disappointed with the Minister’s reply on the issue of restraint applied to mental health patients, which, as the noble Baroness, Lady Barker, pointed out, is an issue affecting adult patients as well as children. The amendment was drafted with precisely that in mind. The point that I sought to make was that, despite the statute law to which the Minister referred, the incidence of restraint on children in particular has rocketed, which raises questions about clinical practice, staffing and training around the code of practice. To my mind, it was a pity that the Minister had little to say about those possible areas for practical follow-up.

I shall read again what the Minister said about my amendment between now and Report. For now, I beg leave to withdraw the amendment.

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I sometimes think that the law, like the Almighty, moves in a mysterious way and is all the more impressive for that. Having just reread the debate that took place on 7 May 2014, when I tabled that amendment, a debate which was both detailed and wide-ranging, including as it did, supportive contributions from the noble and learned Lord, Lord Hope of Craighead, as well as Lord Lester of Herne Hill and Lord Mackay of Clashfern, I can only plead for the Committee’s sympathetic understanding that, inadequate as my efforts clearly were on that occasion, I did my best.

[Baroness Merron (Lab)]

My Lords, I am grateful to the noble Earl, Lord Howe, for his reflection on both the Almighty and our legal friends, and I thank noble Lords for their contributions to the debate on these amendments.

I turn first to Amendment 149 and thank my noble friend Lady Keeley, supported by the noble Baroness, Lady Barker, not just for tabling the amendment but for the time and attention they and their expert advisers have given to this. It has been much appreciated. I take this opportunity to express my condolences to the family of Paul Sammut for the tragic loss of their loved one.

We recognise the concern around unequal coverage and rights to redress under the Human Rights Act. The Sammut judgment highlighted the need to clarify the position of private health and care providers under the Human Rights Act when providing care arranged and paid for by the NHS or local authorities, something that has come up a number of times in our debates. I am grateful to my noble friend Lady Chakrabarti, the noble Lord, Lord Pannick, and the noble and learned Baroness, Lady Butler-Sloss, for their good humour and their expert contributions on this matter. We are actively considering this matter and I look forward to engaging further with my noble friend Lady Keeley and the noble Baroness, Lady Barker, ahead of Report.

On Amendment 160BC in the name of the noble Earl, Lord Howe, supported by the noble Lord, Lord Kamall, deprivation of liberty for the treatment of a physical health disorder is always an important decision. We are concerned that this amendment would, in effect, remove the need for a separate authorisation where physical health treatment is needed. We do not think it is right to undermine the protections available under the Mental Health Act to patients who are already, as we have heard, in a vulnerable position.

Furthermore, the situation this amendment applies to is rare and, where it does arise, there are already frameworks in place to authorise a deprivation of liberty. These include: Section 17 leave under the Mental Health Act; deprivation of liberty safeguards under the Mental Capacity Act; and, in certain circumstances, the High Court. The safeguards provided by these frameworks are different, and decision-makers must use their professional judgment to decide which is most appropriate for the individual. We feel that retaining this flexibility is important.

While we recognise that there is, at times, confusion among clinical professionals around which legal framework to apply—it is a point well made—we do not believe that this amendment would bring the necessary clarity. We feel this is best clarified using the Mental Health Act code of practice. I say to the noble Earl, Lord Howe, that I will reflect on the detailed points that he raised and will be happy to write to him further on them. For all these reasons, I urge noble Lords not to press their amendments.

[Baroness Barker (LD)]

Before the Minister sits down, I thank her very much, but I wonder whether she could include some of the rest of us in her correspondence with the noble Earl? We are back to the same issue of the interface between the Mental Health Act and the Mental Capacity Act. We need to keep coming back to this to get more clarity on it, because nobody understands it now. Whatever the Minister comes up with will be only a sticking plaster until the point at which we recognise that these two pieces of legislation continue to rub up against each other and cause confusion. They need to be addressed together.

So, would the Minister please include more of us in the correspondence, including the noble Baroness, Lady Browning? A number of speeches she has made throughout our deliberations have indicated that this is exactly the sort of issue that she is concerned about, too.

[Baroness Merron (Lab)]

Yes indeed, I will be pleased to include the noble Lords referred to.

[Baroness Keeley (Lab)]

I am very grateful to all noble Lords who have spoken in the debate today, including the noble Baroness, Lady Barker, who has supported the work we have done on this, my noble friend Lady Chakrabarti and Justice, which I should have mentioned earlier. I am very thankful to the noble Lord, Lord Pannick, and the noble and learned Baroness, Lady Butler-Sloss, for bringing their expertise. I thank my noble friend the Minister for her positive response and I look forward to talking to her more about this and taking forward this amendment. But for now, I beg leave to withdraw.