Mental Health Bill [HL]

Debate between Baroness Merron and Lord Scriven

Committee stage
Wednesday 22nd January 2025 Lords Chamber

[Lord Scriven (LD)]

I think one of the reasons why people are asking for an open and transparent review—and, in some cases, one that reports back to Parliament—is that this is about not only the data but accountability for carrying out actions and implementation. That is the bit that is missing. Everything I have heard from the Minister on this subject so far—maybe she is coming on to say something else—suggests that without accountability, and overview and transparency of that accountability, the guidance is not going to work. Believe me, as somebody who used to work in the service: if you know that the Government were looking at this and that it was going to Parliament, it sends a powerful message for action to be taken in each individual unit. That is what is required, and I do not see that coming from the Minister’s answers. Can she tell me where that accountability streak will be, and how we, in this House and the other House, can put pressure on if the guidance is not being followed, based on the process she has outlined?

[Baroness Merron (Lab)]

I understand the point the noble Lord makes. However, it does not lead me to accept the amendments. I understand the intent and I am sure noble Lords realise how sympathetic I am to it, but I repeat the point I made earlier: if one looks at what the amendment actually does, it will not serve that purpose. I take the point about transparency and accountability, and I hope the noble Lord has heard many times that that is very much the mode of direction. Perhaps it will be of some assistance to say that the PCREF will improve data collection on racial disparities over the coming year, and the CQC has existing duties to monitor and report on inequalities under the Act. We will continue to monitor racial disparities in the use of CTOs. That situation will be ongoing. If it is not doing the job that it is meant to do, we will not be complacent and will seek to act.

We agree there is a need to improve organisational leadership—

[Baroness Merron (Lab)]

The noble Baroness is quite right: one has to be able to compare, and that baseline will be in place. You could collect all the data you like, but it has to be meaningful. Her point is well made.

There is a need to improve organisational leadership to improve data collection and change culture across the mental health system. Again, this is exactly what the PCREF is designed to do and something we want to embed further through the revised code of practice.

The creation of a responsible person was an additional recommendation from the pre-legislative scrutiny committee, and it is one we have considered in some detail. However, ultimately, we think that the role is not necessary, because it would duplicate existing roles and duties. There are already duties on providers of mental health services to identify and address inequalities relating to protected characteristics under the Equality Act 2010 and specifically the public sector equality duty. CQC already has a duty under the Mental Health Act to monitor as health services exercise their powers and discharge their duties when patients are detained in hospital or are subject to CTOs or guardianship. It publishes an annual report, Monitoring the Mental Health Act, which includes detailed commentary on inequalities. The PCREF is now part of the NHS standard contract. It has created new contractual obligations on providers to ensure that they have a framework in place to record and address racial inequality in mental health systems and to look at training and other policies to address racial disparities. Ultimately, we do not think that a responsible person is necessary to achieve all the aims, which are understood, set out in the amendment.

Finally, I want to turn to Amendment 138 tabled by the noble Lord, Lord Kamall, and supported by the noble Earl, Lord Howe. We recognise, as I have said, that there are significant inequalities in the use of detention under the Mental Health Act and of CTOs between different minority-ethnic groups, and in particular the overrepresentation of black men. We monitor those inequalities through routinely published data and are improving this data through the PCREF. The CQC, as I have mentioned, reports on inequalities in its annual report under existing duties, but we agree that we lack robust evidence on what drives those inequalities, and that has been a matter of considerable debate in your Lordships’ House. We need to conduct research into this, and we are exploring with experts, including academic researchers, the best way to tackle it.

I am concerned that two years is not enough time to scope and commission the report, collect and analyse new data, and form meaningful recommendations. Additionally, we hope that through improved decision-making under the reforms we will see a reduction in the number and proportion of black men who are subject to the Act and a reduction in racial disparities more generally. It is a major driver of why we introduced the Mental Health Bill. A report after two years feels premature, because it would be likely to be based in reality on data from before the reforms were commenced.

[Lord Scriven (LD)]

I am grateful to the noble Baroness for giving way and sorry for interrupting her flow again. The point about having a staging report after two years is to get ahead and upstream of what is happening rather than retrospectively being able to do stuff after it has gone on. Two years in management terms to be able to determine trends of intended or unintended consequences and then put different things in place is really important. I believe that this amendment, with a report back to Parliament, would send a very strong signal and allow the Government, the department and NHS England to pick up trends, even if it was not the total picture, which would determine different policies and practices and potential changes in the code as well as management action. I think that is what lies behind the noble Lord’s amendment.

[Lord Kamall (Con)]

I am sorry to interrupt at this time. I note that the noble Baroness thinks that 12 months is too short, and many noble Lords can perhaps see the point that two years is too short. Does the department have any idea of what a reasonable timeframe is? There has to be some accountability, as the noble Lord, Lord Scriven, said. We could accept the warm words and the intentions of the Minister here tonight, but what happens if nothing changes? Where is the accountability? Can the Minister think about asking the department whether there is a reasonable timeframe for some meaningful research? I have supervised academic theses over time. You can have the one-year and then you go on to the three-year for PhD, and sometimes that is quite comprehensive data. There might be a meta study that could be done of lots of existing studies. First, what is a reasonable time? The noble Baroness does not have to answer now; it can be in writing. Secondly, if we let this go, how do we make sure there is accountability? How do we come back to this in three years or four years or five years? I look forward to the answer.

Mental Health Bill [HL]

Debate between Baroness Merron and Lord Scriven

Committee stage
Wednesday 22nd January 2025 Lords Chamber

[Baroness Merron (Lab)]

The overall concern is as I have identified. Yes, indeed, as always, it is a complex area that we need to unpick, but our main concern has to be for the welfare of the young person. The concern about the amendment is that, inadvertently, it would work in the opposite direction.

To finish on Amendment 55—this might also be helpful to the noble Baroness, Lady Bennett—we are of the view that the Bill strikes the right balance between self-determination and responding to the needs and vulnerabilities of children and young people. For example, in the clinical checklist, many of the new treatment safeguards and provisions around care and treatment planning apply equally regardless of age and aim to ensure that treatment is more patient-led.

Amendment 56, tabled by the noble Earl, Lord Howe, and supported by the noble Lord, Lord Kamall, is somewhat similar to Amendment 55 in seeking to change the Mental Capacity Act to provide a mechanism by which children and young people can make an advance decision to refuse medical treatment for mental disorder. However, under Amendment 56, the child or young person’s advance decision would have legal weight only if they were detained under the Mental Health Act. As I have already discussed, while we recognise the principled position to extend the rights of adults to children, giving under-18s the right to make an advance decision to refuse treatment would conflict with a long- standing legal principle established by common law in the courts and codified in the Mental Capacity Act and would, therefore, mean that the amendment would not achieve its desired effect. This principle recognises that, in some serious cases, the courts, parents or those with parental responsibility may overrule the refusal of a child or young person, especially in cases where the child’s life is at risk.

I reassure noble Lords that we are nevertheless committed to giving children and young people a voice as far as possible when it comes to decisions about their care and treatment. I refer again to the example of the clinical checklist, which requires consideration of a patient’s wishes and feelings, including those expressed in advance.

[Lord Scriven (LD)]

What legal status does the checklist that the Minister keeps referring to actually have?

[Baroness Merron (Lab)]

I will come back to the noble Lord on that, and I thank him for asking the question.

I was about to refer to the noble Baroness, Lady Tyler. I may not be doing so in quite the right place, so I hope she will forgive me, but I do not want to lose this point. She asked what engagement we have had with the Department for Education. Our officials have engaged with DfE officials on the development of the Bill, including on the interaction between the Bill and the Children Act, which I know is of quite a lot of interest to noble Lords. We have also discussed questions around the statutory test with both the DfE and the Ministry of Justice, given that competency tests apply in wider children’s settings than mental health. I hope that is helpful.

Amendment 136, tabled by the noble Baroness, Lady Tyler, would require the Government to hold a review of whether a statutory test of competence should be introduced into the Mental Health Act for under-16s within a year of the Bill being passed. While we recognise that there are competing views about Gillick competency, it is nevertheless the established framework for determining competency for children. To introduce a statutory test for under-16s only under the Mental Health Act is likely to risk undermining Gillick, which remains the accepted competence test for under-16s across all settings, including reproductive health and children’s social care, and the wider legislative framework on matters related to children.

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[Lord Scriven (LD)]

It is useful, but it is therefore contradictory to what the Minister has just said. If the checklist is statutory and it is legally binding that it has to be followed, how would a young person in that checklist having a view about their care be different from an advance directive? That is the issue. The Minister said the other alternative is that a person under 18 or 16 can make a decision in relation to the medical checklist, and she has just said that the decisions are legally binding. Alternatively, is it that carrying out the process is legally statutorily binding but the views of somebody who is 16 on that list are not?

[Baroness Merron (Lab)]

I was referring more to situations, of which I know the noble Lord is aware, where there is a need for intervention. I think I used the word “overruling”, and I used some examples where there was a risk to life. So it is about application in that regard. I will look at that question in greater detail when I reflect on this area of debate and, if there is more that I can add to assist the noble Lord, I will be pleased to do so.

Amendment 147 is in the name of the noble Lord, Lord Meston, supported by the noble Baroness, Lady Berridge, and spoken to by the noble and learned Baroness, Lady Butler-Sloss, and the noble Baroness, Lady Bennett. It would create a statutory test of competency for children in respect of decisions under the Mental Health Act. Under that test, competence for under-16s would be defined by reference to the functional test of capacity established in the Mental Capacity Act but without the diagnostic test, and by having due regard to the UN Convention on the Rights of the Child.

The courts have already made clear that the approach of the functional test is not suitable for children. We do not think that the functional test is appropriate or compatible with the UN Convention on the Rights of the Child, which the amendment itself makes reference to. The amendment, as drafted, is therefore not considered to be in line with established case law.

The noble Baroness, Lady Berridge, asked about the justification for not including a test in the Bill. As I have mentioned, Gillick is established in case law, not statute, and the code explains how the Gillick decision is to be applied. But this does not mean that the House of Lords decision is not mandatory. There is a duty to follow case law. It is not discretionary, as I know noble Lords are aware.

Mental Health Bill [HL]

Debate between Baroness Merron and Lord Scriven

Committee stage
Monday 20th January 2025 Lords Chamber

[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 in this important and interesting area. There have been, and to some degree still are, many different opinions across the Committee. This has been one of those rare occasions when parliamentarians may say that they have changed their minds having listened to the debate and looked into things further; that has added to the richness of what we have before us.

Amendment 43 tabled by the noble Baroness, Lady Browning, would require clinicians to ensure that patients had access to a local prescribing psychiatrist when deciding on a community treatment order. I heard the noble Baroness’s comments about the word “local”; I appreciate her drawing the attention of the Committee to that. I particularly heard the support given by the noble Baroness, Lady Parminter.

In the Bill, to put someone on a community treatment order, it must be necessary for the patient to receive medical treatment, which can be provided without detention in a hospital. I think I heard the noble Baroness, Lady Fox, say—I hope she will forgive me for not quoting her directly—that we should not demonise hospitals. She is nodding; I thank her for that. I can assure her that there is no intention to do that; it is about getting a better balance in the interests of getting the right care for individuals. The responsible clinician must consider whether appropriate medical treatment is available. That would, by necessary implication, include access to a local prescribing psychiatrist if it is what the patient needed.

For a CTO to be made, our reforms also require a community clinician with oversight of the patient’s treatment in the community to agree. The Bill therefore already means that, when deciding whether a CTO is appropriate, access to a prescribing psychiatrist will be fully and properly considered if access to medication is required.

I recall that the noble Baroness, Lady Browning, raised an important point about the shortage of prescribing psychiatrists in some areas and the impact that this could have. We intend that the measures in the Bill in relation to dynamic support registers will improve the monitoring of the needs of, and support for, people who may be at risk of going into crisis and being detained under the Act. ICBs and local authorities will be required to have regard to information on the register when exercising their commissioning and—we have discussed this before—market-shaping functions respectively.

I mentioned earlier the requirements in respect of learning disability and autism training, and autism training for psychiatrists. I hope that will help to reassure the noble Baroness.

Amendment 44, tabled by the noble Lord, Lord Scriven, and spoken to by a number of noble Lords, including the noble Baronesses, Lady Berridge, Lady Parminter and Lady Fox, and the noble Lord, Lord Kamall, relates to the review into the extension of CTOs. I completely understand why the noble Lord was inspired to come forward with this, having been inspired, as the noble Lord and the noble Baroness, Lady Berridge, said, by the words of the noble Baroness, Lady Parminter, at Second Reading and the way in which she relayed her personal experience. That kind of contribution and the impact that it has is exactly what we welcome, and I am glad she is pleased that people listened— indeed we did.

The amendment would ensure that CTOs aligned with the statement of principles in the code of practice and could be extended beyond 12 months only under certain conditions, with a review of the ongoing necessity and the therapeutic benefit of the CTO. I strongly agree with the intention behind the noble Lord’s amendment but it is fully supported by existing provisions in the Bill. Alignment with the code and the four principles is already achieved by new Section 118(2D), which requires clinicians before placing someone on a CTO to have regard to the statement of principles in the code. Under Clause 6, the patient can be put on a CTO only if there is a reasonable prospect of it having therapeutic benefit for the patient, and the Bill will mean that a responsible clinician cannot extend a CTO beyond six months unless the conditions, including therapeutic benefit, continue to be met.

The current code of practice states that, before renewal, the responsible clinician should consult the multidisciplinary team, the patient, the nearest relative—or, in future, the nominated person—and an advocate. The Bill adds that the patient’s community clinician must be consulted before renewal. We are therefore increasing the frequency of automatic referrals to the tribunal to ensure that patients can come off CTOs when they are no longer benefiting. Under the new system, a CTO cannot be extended past the 12-month point without a referral to the tribunal. In the current system, the patient can go for three years before a further referral is required.

[Lord Scriven (LD)]

That is pleasing to hear from the Minister. So what would stop that going in the Bill?

[Baroness Merron (Lab)]

As we have discussed before, it is about ensuring that we are able to update in line with good practice, and that can be nimbly—if I may use that word—outlined if it is not in the Bill. We are trying to future-proof it, as the noble Lord is aware, and to ensure that our reviews of our practice and so on are continually updated. That is how I would put it to the noble Lord.

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[Baroness Murphy (CB)]

I apologise. Obviously, I was looking at another figure from a different bit of the impact assessment.

[Lord Scriven (LD)]

I think the noble Baroness, Lady Murphy, added up all the years and got to the final cost, and then described it as an annual cost. I think it was a genuine mistake.

[Baroness Merron (Lab)]

I am sure that what the noble Lord, Lord Scriven, said is absolutely right—and the noble Baroness has absolutely no need to apologise.

We intend to implement these reforms in phases, when funding and system capacity allow, prioritising an opt-out approach for detained patients. We will expand eligibility for independent mental health advocates to informal patients only when we are sure that doing so will not impact on the resource available to detained patients.

Turning to Amendments 105 and 106, tabled by noble Baroness, Lady Tyler, and supported by the noble Lord, Lord Scriven, as I mentioned, the extension in the Bill of the right to an independent mental health advocate to inform all patients does include children and young people. With regards to an opt-out approach to advocacy, we believe that detained patients have a particular need, given that they are subject to greater restrictions and are potentially more vulnerable compared with informal patients. The Mental Health Act, its code of practice and the regulations relating to the independent mental health advocate services set out that local authorities should ensure that independent mental health advocates understand equality issues and that there are enough independent advocates with a specialised understanding of the specific needs of particular groups—for example, children and young people. As we revise the code of practice, we plan to provide further clarity on how to meet the needs of children and young people, including through this increased access to advocacy. I hope that this reassurance will be welcome.

The noble Lord, Lord Kamall, asked whether the department was aware of the North Carolina or South Carolina study. As we have all agreed, it is in respect of the North Carolina study. We are running culturally appropriate advocacy pilots in Manchester and Birmingham which are testing the approaches to delivering improved culturally competent advocacy services that support specific preferences and needs of people from minority ethnic groups. We have also commissioned an independent evaluation of these pilots and will be looking at that alongside the international evidence that has been discussed this evening. I am most grateful to the noble Lord, Lord Kamall, for raising this.

For all those reasons, I hope that the noble Baroness will withdraw her amendment.

Mental Health Bill [HL]

Debate between Baroness Merron and Lord Scriven

Committee stage
Monday 20th January 2025 Lords Chamber

[Baroness Merron (Lab)]

I would be pleased to write to the noble Baroness.

As I set out in response to other noble Lords, I hope the Committee has heard how much I agree that the adequacy of training is a key issue. We are aware that developments in best practice in caring for people with a learning disability and autistic people need to be reflected throughout. As I set out, the Health and Care Act 2022 requires that staff be given the training appropriate to their role, and we expect that this should be reviewed in line with the up-to-date situation. The CQC assesses staff training as part of its regulatory function. For these reasons, I ask the noble Lord to withdraw his amendment.

[Lord Scriven (LD)]

My Lords, I thank noble Lords who have taken part in this useful and informative debate, and I thank the Minister for a thorough explanation of what happens. However, there does seem to be a disjoint between what is happening on the ground and what people in an office in Whitehall seem to think is happening. That is why noble Lords have discussed issues to do with data, training, a costed plan, research and development, and the implementation of people who at least have training and an expertise in diagnosis. Something just does not feel right. The Minister has explained what is happening, but without a fully costed plan up front, with targets, accountability and data ongoing, what will happen is what happens now. Things will be diverted and diluted, and we will not be able to hold the plan to account. For that reason, while I thank the Minister for the explanation she has given, I feel that we will return to this issue at a later stage to dig down and get that deliverable framework. In the meantime, I beg leave to withdraw my amendment.

Mental Health Bill [HL]

Debate between Baroness Merron and Lord Scriven

Tuesday 14th January 2025 Lords Chamber

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

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

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

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

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

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

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

[Lord Scriven (LD)]

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

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

[Baroness Merron (Lab)]

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

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

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

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

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

Mental Health Bill [HL]

Debate between Baroness Merron and Lord Scriven

Tuesday 14th January 2025 Lords Chamber

[Baroness Merron (Lab)]

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

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

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

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

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

[Lord Scriven (LD)]

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

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[Baroness Merron (Lab)]

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

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

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

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

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

[Lord Scriven (LD)]

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

[Baroness Merron (Lab)]

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

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[Lord Scriven (LD)]

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

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

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

[Baroness Merron (Lab)]

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

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

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

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

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

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

--- Later in debate ---

[Lord Scriven (LD)]

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

[Baroness Merron (Lab)]

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

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

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

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

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

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

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

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

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

Adult Social Care: Long-term Workforce Plan

Debate between Baroness Merron and Lord Scriven

Monday 13th January 2025 Lords Chamber

[Baroness Merron (Lab)]

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

[Lord Scriven (LD)]

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

[Baroness Merron (Lab)]

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

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

Hospice Funding

Debate between Baroness Merron and Lord Scriven

Monday 6th January 2025 Lords Chamber

[Baroness Merron (Lab)]

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

[Lord Scriven (LD)]

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

[Baroness Merron (Lab)]

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

Health: Quad-demic

Debate between Baroness Merron and Lord Scriven

Tuesday 10th December 2024 Lords Chamber

[Baroness Merron (Lab)]

We are aiming communications —I know the noble Lord will be familiar with this from his previous role—particularly at groups that are less represented in terms of vaccinations. From my discussions with the national medical director, I do not recognise the reference that the noble Lord made to hospitalisations; they are as I set out in the Answer to my noble friend. However, we are far from complacent and continue to push vaccination. We will get vaccination rates up because they are the best line of defence against infectious diseases.

[Lord Scriven (LD)]

My Lords, the chief medical officer at the UK Health Security Agency stated last week that NHS staff should get the flu vaccination. The Government’s own statistics show that last week, in the largest trust in the country, only 7.9% of those eligible had had flu jabs, and on average the number is in the lower 20%. Why has this happened? What are the Government doing urgently to improve the take-up of the flu vaccine by NHS staff?

[Baroness Merron (Lab)]

I must be honest: I cannot explain here the exact reasons why NHS staff are not taking it up, but I assure the noble Lord, as I have assured other noble Lords, that our focus is on getting vaccination rates up. That is why the national medical director made the comments that he did, as well as assuring me that we are not nearing a pandemic.

NHS Plan: Consultation

Debate between Baroness Merron and Lord Scriven

Monday 2nd December 2024 Lords Chamber

[Baroness Merron (Lab)]

I agree with my noble friend: we have to hear from unpaid carers, because that will strengthen the exercise. We are constantly monitoring which groups are responding and which are not, and that allows us to tailor our approach to the underrepresented groups who are not coming forward. If that includes unpaid carers, the consultation absolutely will make special, tailored efforts to reach them.

[Lord Scriven (LD)]

My Lords, the life expectancy of people with learning disabilities is, on average, 20 years less than the general population’s. Research has shown that a major contributor to this is a lack of access to appropriate healthcare. What will the Minister do to ensure that this group of people will be not only consulted but listened to, and that the 10-year plan will provide appropriate services tailored to them?

[Baroness Merron (Lab)]

This is indeed one of the groups for whom we need to ensure absolute inclusion. As I mentioned, the work with integrated care systems will be particularly helpful in running the workshop. We train organisations to work with it, and it is designed so that it is easy to use. It can be used in events to reach the seldom-heard voices in communities, including those with learning disabilities. It is vital that we hear from them as we design an NHS fit for everybody for the future.

NHS: Dentistry Provision

Debate between Baroness Merron and Lord Scriven

Monday 25th November 2024 Lords Chamber

[Baroness Merron (Lab)]

I commend the noble Lord for raising his long experience of facing and dealing with these problems locally in Norfolk. I note the report in September that the Norfolk and Waveney area has the worst ratio of NHS dentists to patients in England, with 1,000-plus people having to attend Norfolk’s casualty department last year due to serious dental issues, so this is a serious point. We are aware of the University of East Anglia’s interest in this area, and my colleague Stephen Kinnock, the Minister responsible for this area, recently met with east of England MPs to discuss this matter. However, as I have said, it is not the Government who make these decisions, although we encourage those new dental schools to be in areas of particular need. I encourage the University of East Anglia to take its proposals to the General Dental Council.

[Lord Scriven (LD)]

My Lords, has any extra allocation been made in-year—this year—from the Budget’s NHS allocation for the extra appointments the Government wish to see in dentistry, or is this expected to be bought from existing ring-fenced dentistry budgets?

[Baroness Merron (Lab)]

My Lords, the Government are investing around £3 billion in dentistry each year. As the noble Lord will be aware, I cannot yet confirm 2025-26 dentistry budgets, but they will be confirmed in planning guidance published by NHS England in due course. I know that the noble Lord will be aware that, despite the tough fiscal circumstances the Government have inherited, the Budget set out a big increase in day-to-day spending for health and social care. Regarding the process, and our planning, it is entirely normal that we set out matters in planning guidance. We are, of course, keen to reform the dental contract with a shift to focusing on prevention and the retention of NHS dentists. That work is immediately under way.

NHS: Treatment of Children from Other Countries

Debate between Baroness Merron and Lord Scriven

Thursday 21st November 2024 Lords Chamber

[Baroness Merron (Lab)]

I will be glad to take back to the department the comments of the noble Baroness and the noble Lord, but I reiterate that it is individual expert centres that are responsible for liaising with referring clinicians. By definition this has to be done on a case-by-case basis because we are talking about highly specialised treatments for rare diseases. Again, there is no set nationwide policy for local implementation because of the very nature of the challenge and the specialism to which the noble Baroness refers.

[Lord Scriven (LD)]

My Lords, maybe a good place to start would be to be bolder and more ambitious with the rare diseases framework that already supports international collaboration as part of the Government’s policy. As part of this framework, will the Minister investigate setting up an international centre of excellence in the UK that could be funded by both the UK and international partners for procedures and R&D to be carried out here, which would deal with some of the problems that both noble Lords have mentioned?

[Baroness Merron (Lab)]

The noble Lord is right to make reference to the UK rare diseases framework. The intention of that is to improve the lives of those with rare diseases—for example, by helping to get a faster diagnosis, increasing awareness of rare diseases, better co-ordination and care, and improving access to care, treatment and drugs for those in this country. I will add his suggestion to the list of matters to raise with the department.

National Insurance Contributions: Healthcare

Debate between Baroness Merron and Lord Scriven

Tuesday 19th November 2024 Lords Chamber

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

I assure the noble Lord that there is no intent to squeeze out any providers, which are much valued and appreciated. We will continue to listen to their concerns and consult them as we make allocations, which is, as he knows, the usual practice for every Government. On the Budget settlement for the Department for Health and Social Care for 2025-26, I assure him that the Chancellor considered the impact of all the changes in the Budget.

[Lord Scriven (LD)]

My Lords, the net cost to the already struggling community pharmacy sector from the national insurance changes is roughly £50 million. One community pharmacist told me last week that this means that they either reduce services to patients by closing for the equivalent of one day a week or make one and a half members of staff redundant. What advice would the Minister give to that community pharmacist and many others in her situation?

[Baroness Merron (Lab)]

What I would say to each sector, including pharmacists, about the services they provide and what is expected in return from any contract is that, as in previous years—I emphasise that it is business as usual in this respect—employer national insurance contributions are dealt with as part of the process. We are very appreciative of the pharmacy sector’s contribution, not least because it will assist with one of the three pillars in moving from hospital to community services. I encourage all pharmacists to work with us to achieve what I believe they and we in government want: a service that is fit for the future.

Human Medicines (Amendments Relating to Naloxone and Transfers of Functions) Regulations 2024

Debate between Baroness Merron and Lord Scriven

Tuesday 22nd October 2024 Grand Committee

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

My Lords, this draft statutory instrument proposes amendments to the Human Medicines Regulations 2012, which will expand access to naloxone, a life-saving medication that prevents death from opioid overdose. In addition, this draft statutory instrument makes amendments to keep the regulations current by updating references to Public Health England and the Health and Social Care Board, following the dissolution of those bodies.

We know the devastating impact that illicit drugs cause. Drugs destroy lives, tear families apart and make our streets less safe. Drug misuse deaths have doubled in number over the past 10 years, and we know that people who die from drug misuse often do so at a tragically young age, often in their 40s. Almost half of drug misuse deaths in 2022 involved opiates such as heroin. These deaths are avoidable. Dedicated drug treatment services provide the path to recovery and this Government are continuing to ensure that treatment is available and of high quality.

However, we also know that over half of people struggling with opiate addiction are not engaged in treatment. These are incredibly vulnerable people who often have multiple and complex needs; they are at increased risk of accidentally overdosing and dying. Tackling this issue supports the Government’s health mission. It will ensure that people can live longer, happier and healthier lives, and it chimes in with our collective efforts to break down barriers to opportunity and create a fairer society.

Naloxone is a highly effective antidote to opiate overdose. It can already be administered quickly and safely by anyone in an emergency, but current regulations specifically enable only drug and alcohol treatment services to supply it for future use without a prescription. That limits the reach of this life-saving medicine.

The draft instrument that we are debating today proposes two key UK-wide changes to existing regulations: first, to expand the list of services and professionals named in the regulations who can give out naloxone without a prescription. That means that professionals such as registered nurses and probation officers will be able to provide take-home supplies of naloxone where appropriate, should they wish to do so.

Secondly, it proposes to establish national registration services across the whole UK. This will enable other services and professionals who are not able to be named in the legislation but who come into contact with people at risk of overdose, including housing and homelessness services, to register and procure naloxone.

There is a positive background to these changes. The Department of Health and Social Care consulted on them at the beginning of this year and received over 300 responses spanning a range of organisations and professionals from across all four nations of the UK. Of these responses, approximately 95% agreed with the proposals that are set out. This demonstrates the level of interest in this important issue and the breadth of support for the changes we are seeking to achieve.

These changes have also been called for by experts in the sector such as the Advisory Council on the Misuse of Drugs in its review of naloxone in the UK. In addition, Dame Carol Black recommended naloxone provision as an important harm reduction measure in her two-part independent review of drugs.

Allowing more services and professionals to supply naloxone will mean easier access to it for people at risk, which in turn will mean lives saved. With the growing threat posed by synthetic opioids, which are often more potent and more deadly, the importance of this work only continues to increase as time goes on.

I want to provide reassurance that, with these changes, there is no compromise on safety. Naloxone is very safe and effective, even when administered by a layperson with no prior experience. It has an effect only if the person has been taking opioids and it is already widely used across the UK and internationally.

We are taking steps to mitigate against any very limited risks associated with wider access. We will provide updated guidance for services in scope, and we will set out robust requirements for training and safeguarding. I reassure the Committee that the intention of these changes is not to create additional burdens for services, particularly as we are aware that many of those in scope will already be facing pressures. These new powers are enabling, not mandatory. They provide an opportunity for increased provision, based on local need, but they do not make any requirements.

Finally, addiction is not a choice. It is often fuelled by wider issues, such as trauma and housing instability. This is a complex public health issue and must be tackled as such. We must change the narrative on addiction to one that is about the prevention of drug use, the reduction of harm and enabling recovery. The changes we are discussing here will save lives. On this basis, I beg to move.

[Lord Scriven (LD)]

I thank the Minister for setting out the rationale for this draft statutory instrument so well. I agree that this is a step forward in the ongoing battle against the devastating impacts of opioid overdoses. As she said, opioid overdoses have reached alarming levels, claiming thousands of lives every year. According to the latest statistics, opioid-related deaths have surged alarmingly in most regions. This is not merely a statistic. This is about the loss of lives, families shattered and far too many left to grieve, so it is important to take further action that is effective and wrapped in compassion. The temporary measures taken in Scotland show that the changes outlined in these regulations work and will save lives.

Naloxone, when used in the right place at the right time, is a life-saving medication. This draft statutory instrument will facilitate local supply networks, ensuring a broader distribution system and therefore more effective use of naloxone, empowering, among others, healthcare professionals, the police, prison and probation staff, and people in the youth justice system to facilitate the supply of this life-saving drug.

In response to one of the issues that the noble Baroness raised, a question occurred to me. As this will not be a mandatory provision across the country, how will the Government monitor lives that could be saved but that may not be saved because of a lack of take-up of this in certain towns, cities or regions? It could end up that a life will be saved if one body decides to do this, while a life could be lost in a neighbouring county, city or town if that does not take place.

One of the key provisions in this draft statutory instrument is the move to enable the friends and family of those at risk to administer this drug. Allowing those closest to individuals at risk to carry and administer naloxone creates a lifeline that will, literally, make the difference between life and death.

I listened to what the Minister said about setting up local naloxone providers and supply co-ordinators, and I have read the draft statutory instrument and the explanation—but I am still not clear about what regulatory oversight of these bodies will be in place. Who will be the regulator and what powers will they have to deal with the improvement or, indeed, withdrawal of such a service if it is deemed that the local provider is not carrying out the rules laid down in the draft statutory instrument?

Clearly, the broader implications of these amendments are not merely about the use naloxone but about standing with those who struggle with addiction, and their families. These amendments are an essential evidence-based response to the dramatic increase in opioid use and overdoses. By enabling greater access to naloxone, they will help to save lives.

--- Later in debate ---

[Baroness Merron (Lab)]

My Lords, I am grateful to the noble Lord, Lord Scriven, who I do not believe I have had the opportunity of welcoming formally to his new Front-Bench role. I am delighted to do that today; he is most welcome. I very much look forward to working with him and hope that he enjoys his role. I am also grateful to the noble Lord, Lord Evans, as ever, for his contribution.

I am pleased that both noble Lords, on behalf of their Front Benches, have been so positive in welcoming these regulations. I certainly agree with the closing words of the noble Lord, Lord Scriven: in doing this today, we are standing with those who struggle with drug use and with those around them—the communities, their families and their friends. It is with that motivation in mind that we are doing this.

I will of course write to noble Lords if there are any points that I do not manage to cover adequately. To pick up some of the points, however, the noble Lord, Lord Scriven, asked who will regulate. As part of the legislation, as I said in my introduction, there will be training and data-reporting requirements attached to both routes for new providers. Those new providers could be the emergency services, for example, and they will have to report on levels of prescribing so that effectiveness and safety can be monitored. That will absolutely be required of them.

[Lord Scriven (LD)]

The Minister might not still welcome me to my place now but although I understand that, my point was: what powers do those whom they report to have in ensuring compliance? That is the bit I did not get from reading the regulations.

NHS: Independent Investigation

Debate between Baroness Merron and Lord Scriven

Tuesday 8th October 2024 Lords Chamber

[Lord Scriven (LD)]

My Lords, I thank the Minister for bringing the Statement to the House. You do not have to be a mastermind to realise that the NHS is straining at its seams. It is only down to the great work of the many thousands of people who work in the NHS that millions of people get great care, even though some fall between the cracks.

The Darzi report is a very good medical history and it gives a diagnosis, but we all know that the treatment plan is going to be the important point if we are to deal with a reformed, new and productive NHS. There are some welcome themes in the report that are not new. Those who know the previous Darzi report will see have seen some of them before: prevention; moving resources from hospital care to primary and community care; dealing with the wider determinants of health; improvements in and parity for mental health; and a bigger role for public health.

I understand that the Minister will answer many questions by saying that we need to wait for the 10-year treatment plan, and probably the Budget, before such specific questions can be answered, but I have a few general questions for the Minister, to get at least a sense of the direction that the Government wish to take.

Is it the Government’s intention to restore the public health grant back its 2014 levels? Are there any general views about looking at changing the structure of public health, nationally or locally? On capital, what is the Government’s thinking about the general theme of allocation to hospital and non-hospital services, and how will this be managed and monitored? On data, what is the Government’s thinking on the workforce plan, particularly when there is a huge imbalance when it comes to digital and data between the private sector and skills within the NHS? That is not to say that there are not some good skills within the NHS, but there is clearly an imbalance.

Welcome as it is that the report talks about moving resources from hospital to non-hospital settings, I was a manager in the health service in the early 1990s and I know that this has been said since at least the 1970s. What are the Government going to do to be able to move resources from sunk costs in the acute sector into other sectors? What mechanisms will be put in place? How will this be monitored? More importantly, who will be held accountable for making sure that it actually happens? How will the new neighbourhood approach affect the existing workforce plan? If a new health service is anticipated, what will the effect be on the workforce plan and the implications for capital allocation?

We all want to see a productive and effective healthcare system that improves peoples’ health and independence, but that cannot be brought about if we do not have a strong, effective, well-funded social care system. I do not understand why social care has been kicked down to the next Parliament, or how we are going to solve the health and well-being of the population without that being done. If the major reforms of social care are in the next Parliament, what steps are the Government going to take in this Parliament to deal with the social care crisis?

I look forward to the Minister’s answers, but, more importantly, to the 10-year treatment plan’s arrival in the next few months.

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

My Lords, I thank the noble Earl, Lord Howe, and the noble Lord, Lord Scriven, for their opening observations. I will seek to deal with as many of them as I can; I am sure a number will be iterated in the course of the Back-Bench contributions.

I start by expressing gratitude to the noble Lord, Lord Darzi—my noble friend, if I can call him that—for what I regard as an open, honest and thorough review. He is known as a man of great service, not just to your Lordships’ House but to the National Health Service. He has served Labour and Conservative Governments with distinction. As noble Lords will be aware, he is an eminent cancer surgeon who has driven innovation and speaks up for staff and patients. It is not surprising to me that the Secretary of State asked him to conduct this review, tasking him to provide what we might refer to as hard truths, warts and all. I realise that when one asks for that it can be uncomfortable, but I hope that we in your Lordships’ House can sit with discomfort in order to find a way forward for the National Health Service.

The noble Earl, Lord Howe, referred to the terminology that the NHS is “broken”. I understand that that is uncomfortable to hear, but when I speak to NHS staff they recognise that terminology. We are at great pains to say that we are not being critical of NHS staff, but unless we start in an honest and open fashion we will not be able to—as the noble Lord, Lord Darzi, referred to—restore the trust that is necessary. As the Secretary of State said in the other place, this Government have resolved to be honest about the problems faced and serious about fixing them. That is why he commissioned this independent investigation. I very much hope that noble Lords can be of assistance in finding the way forward, because we now have a diagnosis on which we can consult and then move on to the necessary prescription to improve the health of our National Health Service.

The noble Lord, Lord Scriven, referred to the 10-year plan. I am glad that he looks forward to it—as do I—but how will we get there? We now have a very clear explanation of where we are. It is evidenced and has widely involved many people and organisations. It should therefore be regarded with great respect, and I think it largely has been. However, the next stage for the 10-year plan will be to have what will be the biggest consultation we have ever had in this country on the National Health Service. It will involve patients, staff, parliamentarians, stakeholders—all those who have a vested and informed interest in it. That will lead us to the 10-year plan. On the question about this being top-down, this is very much a bottom-up exercise, with the Government’s commitment underlying it.

It is important to say that the 10-year plan does not mean that we will wait 10 years for everything. We will identify those areas in which we can make swifter progress and we can then look beyond. The fact is —this came out many times in the report from the noble Lord, Lord Darzi—that this has been a long time in the making and to turn it around will not be quick.

The noble Earl, Lord Howe, acknowledged that there were problems in the NHS. I am grateful for that and for his reference to the need for change. I also listened closely to his reference to what had been done under the previous Government. Facts are facts, but what matters is output. As we are discussing today, whatever the previous investment and previous actions, some of which were very much to be commended, the output has not delivered the results we need. That is why we have the report by the noble Lord, Lord Darzi.

On the issue of dedicated staff, the staff team to whom I pay tribute goes way beyond clinical staff, important as they are, and includes the cleaners, porters and administrators. Noble Lords will recall that, when the workforce plan was published, we said that this was a useful step forward. Our job now, as a new Government, as the noble Lord, Lord Scriven, said, is to adapt the plan to ensure that it brings in one of the three pillars we will be going for: hospital to community. That will absolutely be our focus.

I note that the noble Earl, Lord Howe, does not accept the assessment by the noble Lord, Lord Darzi, of the Health and Social Care Act 2012. I see the noble Lord, Lord Lansley, in his place; I am sure he will have a contribution to make. I have to part company with the noble Earl on that point, as the evidence in the review is that the Act did not work in the direction we were seeking to take.

On capital expenditure, we find ourselves with a massive backlog of capital works, such that the ability of the NHS to deliver is being held back by the buildings and facilities. We have therefore instructed a review of this, which we will then look to.

Finally, the noble Lord, Lord Scriven, was generous enough to say that he does not expect me to respond to the detailed questions about funding. However, I can assure him that all these matters are being considered—in other words, how we can best deliver the output and the improvements in health that the report of the noble Lord, Lord Darzi, seeks to achieve.

Pharmacies: Rural Areas

Debate between Baroness Merron and Lord Scriven

Tuesday 10th September 2024 Lords Chamber

[Baroness Merron (Lab)]

I will be very happy to look at the work that the noble Earl refers to. If he would like to meet me to discuss it, I am sure that would be of great assistance as we look to the future.

[Lord Scriven (LD)]

My Lords, there is a crisis in community pharmacies, as the Minister will know. Two weeks ago, the industry brought out a report that predicted that one in six community pharmacies could close within the next year. What urgent action will the Government take to ensure that that does not happen?

[Baroness Merron (Lab)]

On the point that the noble Lord correctly raises, it is worth reflecting that there has already been a reduction in the number of pharmacies since 2017. There are now some 1,200 fewer pharmacies than we had in 2017 and 600 fewer than there were two years ago. This is a trajectory that we would rather was not the case. Support is available—for example, through the Pharmacy Access Scheme, which provides financial support to pharmacies in areas where there are fewer pharmacies. I can say that we are monitoring access to pharmacies. While it is the case that four in five people live within a 20-minute walk from a community pharmacy, we absolutely recognise that the experiences of patients differ. If we are to see pharmacies as key to future plans for the health services, we will have to address that.

Coronavirus: UK Deaths

Debate between Baroness Merron and Lord Scriven

Monday 29th July 2024 Lords Chamber

[Baroness Merron (Lab)]

I thank the noble Baroness for her kind welcome. Of course, this was a decision taken by the last Government, supported by the Official Opposition. I would say that these kinds of factors were complex rather than “less complex”. Nobody wants to have to lock down a country, but there are rare occasions when we have to consider that. Of course, circumstances changed under lockdown: the fantastic work of the vaccination programme and the vaccine allowed us to unlock. So it is always a moving feast—but I take note of the noble Baroness’s point about the impact on young people.

[Lord Scriven (LD)]

My Lords, the last Government decided to stop various methods for testing Covid-19 last year, other than for those in hospital. Other countries, including the USA, still collect data and the World Health Organization publishes it. So could I ask the Minister to help with public health screening and planning? Will the Government potentially look at this kind of testing being done again and the results published?

Northern Ireland Dentists: Amalgam Fillings

Debate between Baroness Merron and Lord Scriven

Monday 22nd July 2024 Lords Chamber

[Baroness Merron (Lab)]

I am sure that there are many opinions in your Lordships’ House about what would have happened if we had not left the EU, and I think it is probably appropriate that I leave it there.

[Lord Scriven (LD)]

Does the Minister agree that it is the policy of the British Dental Association eventually to remove amalgam, so this is about not whether it is removed but the timing of its removal, in a way that helps to ensure continual dental services?

[Baroness Merron (Lab)]

It is indeed, and I thank the noble Lord for his observation, which is absolutely correct. We are very grateful to the British Dental Association for working closely with us not just on this issue but on how we are going to restore NHS dental services across the country, because that is a real task we are going to have to battle with.