Health Bill

Baroness Tyler of Enfield Excerpts

Committee stage
Tuesday 3rd November 2026 Lords Chamber

[Lord Patel (CB)]

My Lords, I strongly support the amendment in the name of the noble Baroness, Lady Shawcross-Wolfson, and I have added my name to it. She spoke so eloquently and made her case so strongly that I have put aside what I have written down because it would have been a repetition of what she had already said. I am going to take a slightly different tack but make the same point.

The noble Baroness quite rightly linked education, training and workforce planning. You have to know what workforce you might require for the health service you plan to have. I guess one can say that the Government’s 10-year health plan and the 10-year cancer care plan outline the kind of health service that the Government wish to see develop over the next 10 years. If that is the case, we need to address what kind of training and education and what kind of people we will need to deliver that plan.

I am guessing now that the reason why the 10-year workforce plan is delayed is because the premise on which it was to be formulated was that technology such as AI and digital technology would free a lot of clinical time, and hence the headcount need not be so high. That is a false assumption. It is false because we need to train people to use AI and digital technologies. The assessment is that, if you use these technologies, you might free about 40 minutes a day for front-line clinicians. With the pressure that the NHS now faces and the needs of the workforce it now faces, that time will be used to deliver better care to patients, particularly as the 10-year health plan identifies that technologies such as genomics and personalised medicine will be the way healthcare will go. There is an ambition by 2040 to have 50% of patients with some idea of their genomics, and the treatment is therefore based on that.

If you add all these together, and the Secretary of State now has responsibility for education, training and workforce planning, you ask the question: why is the workforce plan delayed? It is delayed because maybe the penny has dropped that, if you do not count the numbers and do not present a case about how technologies will reduce front-line clinical time, then you cannot plan the workforce.

Furthermore, I wonder whether the Bailie review of productivity in the NHS is based on the premise that greater productivity will be delivered in the NHS because of using technologies such as AI and digital technologies. We do not know that that will happen, but we have to wait until the Bailie review comes out. I wonder whether that is another reason—the Minister might comment on that—why the workforce plan is delayed.

It might be political pressures, it might be fiscal pressures or it might be the pressures from not knowing how to get the workforce numbers that we would require to deliver the 10-year plan and the cancer care plan that are holding up workforce planning. However, as the noble Baroness, Lady Shawcross-Wolfson, pointed out, if we do not have a plan, things will get worse. We will introduce technology, which will not be across the board, and we will then look for workforce that is not trained to deliver it. I hope the Minister will give us some answers about where we are going.

[Baroness Tyler of Enfield (LD)]

My Lords, I was very pleased to add my name to the two amendments tabled by the noble Baroness, Lady Hollins, Amendments 92 and 252, regarding the mental health workforce. More generally, I was very taken by the way this important group of amendments was introduced by the noble Baroness, Lady Shawcross-Wolfson, because she is right that all the things that we have been talking about in this Bill so far—all the things we all want to see to improve the health of this country, and all the things we want the NHS to be able to do with, yes, efficiency and increased productivity but also with great care and compassion—will none of them be achieved unless we have the right workforce with the right skills and the education and training in place. That is why I think this is such an important group of amendments.

As I said, I was very pleased to add my name to the two amendments tabled by the noble Baroness, Lady Hollins, on the mental health workforce. She set out the case clearly, so I do not need to do it again. I simply reiterate that, once we have the long-awaited NHS workforce plan, this will be vital. I would be grateful if the Minister could make some commitment here about how quickly we will see a follow-up mental health workforce plan. We need to see some detail about how the mental health workforce will be recruited and retained and will be able to meet the scale of the mental health demand, which we have debated so many times on so many occasions. That is critical. Both those amendments are important in that respect.

My final point is that, during the passage of the Mental Health Bill, in which many noble Lords here were involved, we all quite rightly thought how important it was that as many mental health services as possible should be located in the community. We all agreed with that; it was the premise, as it were, on which the rest of that legislation was built. As important as the consultants and psychiatrists and so on are—of course they are; it is a wide-ranging workforce and includes mental health nurses and others as well—unless we have that workforce in the right place, in the community, appropriately skilled, educated and trained, we will never be able to deliver those community mental health services, which are so vital. So I was very pleased to support these amendments.

[Lord Kakkar (CB)]

My Lords, I support the amendment in the name of the noble Baroness, Lady Shawcross-Wolfson. It is an important amendment raising two fundamental questions, which I hope the Minister will be able to answer. The first is this: ultimately, in preparing a workforce plan that will enjoy broad confidence, there must be external scrutiny of that plan. It would be most helpful if the Minister could confirm how His Majesty’s Government’s healthcare workforce plan will be independently scrutinised. Also, how will His Majesty’s Government be able to reconcile potential differences generated as part of that independent scrutiny with what they consider to be deliverable at this particular moment in time?

The second issue is how a mechanism will be secured—now that the functions independently exercised in NHS England will become the responsibility of the Secretary of State for Health—in respect of long-term workforce needs and short-term financial pressures. As we have heard, investment in the workforce is a long-term investment, and Ministers will always be faced with short-term financial problems and crises. Historically in the NHS, the education and training budget has been periodically sacrificed when there have been other service, access and delivery demands on NHS institutions.

In providing an opportunity now with this Bill, how will the Government address that fundamental tension and secure a mechanism both for independent scrutiny and to ensure—with all the powers now lying in the hands of the Secretary of State for Health—that the education and training budget that secures the long-term development of the workforce cannot be sacrificed for short-term exigencies?

Health Bill

Baroness Tyler of Enfield Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, it is a great pleasure to follow the noble Baroness. As the noble Lord, Lord Patel, has already made very clear, this is a very important group of amendments: it gets to the nub of what we should be talking about for the NHS. If I am honest, quite a few of these amendments are calling for quite similar or interconnected things and outcomes. I do not mind too much how we get there, as long as we do.

I want to speak specifically to Amendment 18 in my name; I thank the noble Baronesses, Lady Royall, Lady Cass and Lady Lister, for adding their names. I will also briefly touch on Amendments 8 to 10, in the name of my noble friend Lady Walmsley, who, sadly, is unable to be in her place today, and to which my name is added. I will also speak—briefly, I hope—to Amendment 14 in the name of the noble Lord, Lord Patel of Bradford, who is also unable to be in his place; again, my name is attached. There are also other very important amendments in this group to which I am very sympathetic, in particular Amendment 20 in the name of my noble friend Lady Pidgeon.

The case is well known and has been well made already, so I will very briefly say why tackling health inequalities more effectively is so important. All the research shows that the nation’s health is under real strain. Analysis of healthy life expectancy internationally shows, sadly, that we are falling behind. We now have an 18-year gap in life expectancy between different postcodes in the UK. Of course, it is not just about health, important as that is to individuals, but about economics—what I like to call well-being economics. A nation cannot prosper while large parts of its population are having their lives cut short and while its most deprived communities are, on average, living only 52 years in good health. The number of people with a work-limiting health condition is rising, and poor health among young people is one of the drivers of the increasing number of 16 to 24 year-olds who are NEET—not in education, employment or training.

Before we get too despondent, if you flip it on its head, the good news is there is real potential for what I would call health-enabled growth. Modelling by the Health Foundation suggests that returning just to 2014 levels of health would see 600,000 people back in work, grow GDP by 2% and save the Treasury £70 billion nationally.

I think we all understand that health inequalities are driven not simply by how the NHS functions and operates but by wider social, economic and environmental factors, including poverty, poor-quality housing, lack of green space, poor working conditions and barriers to accessing affordable and nutritious food. I know that, if she were here, my noble friend Lady Walmsley would really want to emphasise that.

As others have already pointed out—the noble Lord, Lord Patel, made this point very strongly—there is a real opportunity to place in the Bill a stronger duty on the Secretary of State to improve health and reduce health inequalities, but that needs to be supported by a statutory framework for co-ordinated cross-government action and accountability. It is an overall package we need, if you like. Coupled with consistent joint working at national and local level, this could really support the shift that I think we all want to see from sickness to prevention. It is in the 10-year plan and the devolution agenda.

Health Bill

Baroness Tyler of Enfield Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I underline first of all what the noble Lord, Lord Hunt, said about how very less than ideal it is to be dealing with an important group of amendments of such sensitivity this late in the day, but we are where we are. I very much support the amendments put forward by the noble Lord. I remember clearly my personal anguish at not being able to visit my mother for a long time in her care home. It really was agony for me. What happened during Covid must never be allowed to happen again. I think of those care home residents who died without the love and support of any of their relatives by them. It is an absolute scandal. It is shocking. We must make sure it does not happen again.

My amendments are about unpaid carers and their relationship with the NHS. As we know, unpaid carers have very frequent contact with the NHS, but recognition and support for them can be very variable indeed. This Health Bill presents an important opportunity to place essential rights and support for unpaid carers in legislation for the first time, to bring them on a par with existing rights that carers already have in relation to local authorities. My amendments are designed to improve the identification, health and well-being of carers, as well as improving the provision of breaks, to which they should be entitled.

There are some 4.7 million unpaid carers in England, and the value of carer support is worth £152 billion in England alone. That happens to be about the same as the budget of the whole NHS. We have so many unpaid carers that they are holding the NHS together.

Turning to Amendment 88, on the duty to identify and record unpaid carers, the Care Act 2014 already places duties on local authorities relating to the identification of unpaid carers, but no equivalent duty exists for integrated care boards, which commission in the vast majority to health services. Unpaid carers are more likely to come into contact with health services earlier than they are with local authorities, and there is evidence of significant underidentification of unpaid carers within the NHS. Analysis by the Nuffield Trust of 13 million GP records found that for every one carer identified by GP practices, four were not, meaning around 1 million carers were effectively missing from GP records. So, there are real problems with identification rates, which are compounded by the fact that more carers are identified in affluent areas than in deprived areas.

There are many cogent reasons why identification is important. For example, public health measures can be targeted at unpaid carers, such as free flu vaccinations and assessments for common health problems. Winter pressures on the NHS can be alleviated with targeted support and advice for unpaid carers, and of course, inclusion of unpaid carers in hospital discharge planning could help to reduce avoidable readmissions. That is just to name but three.

The last key point I will make here is that, ironically, unpaid carers can take a long time to identify themselves and understand that they are carers. In fact, some research I saw said that for some 36%, it took up to three years to understand they were a carer. Without a statutory duty, I fear that identification of carers will continue to depend on local priorities and resources. While some areas have excellent systems, others identify very few carers. A statutory duty here would introduce much greater consistency.

Amendment 89 would place a duty on ICBs to promote the health and well-being of carers. I think we all know that unpaid carers consistently experience poorer physical and mental health outcomes than non-carers: they just forget and neglect their own health needs. I have just one statistic here: the GP Patient Survey 2025 found that 72% of carers reported a long-term condition or disability, compared with 60% of non-carers. Many carers are just not able to prioritise their own health. Most tellingly, Carers Week research from last year found that 40% of current carers said they had postponed or cancelled a medical appointment, test, scan, treatment or therapy because of caring. That is an estimated 4.8 million people. My final point here is that ICBs rely heavily on unpaid carers to keep people well at home and reduce hospital admissions. Therefore, supporting carers’ health, I maintain, is vital to NHS sustainability.

Finally, my Amendments 175 and 176 are about a right to a break for unpaid carers and a national respite scheme, and I very much thank other noble Lords who have added their names to these amendments, and to all my amendments in this group. These two amendments essentially do the same thing: they ensure that carers who are assessed as being entitled to a break actually receive one, because although many carers in England are entitled to this assessment under the Care Act, many assessments just do not result in meaningful breaks or replacement care. There are many statistics here, but I will mention just one: official data from 2023-24 shows that only 8% of all unpaid carers were assessed or supported by their local authority, which is a shockingly low figure. Unsurprisingly, carers describe severe exhaustion, burnout, isolation and worsening mental health resulting from being unable to step away from these caring responsibilities.

Local flexibility in the delivery of breaks has too often resulted in inconsistency and postcode variation. Whether an unpaid carer can access a meaningful break should not depend on where they live or the financial pressures facing their local authority. That is why Amendment 176 also establishes a requirement for the Secretary of State to provide financial assistance to deliver this. There was much more I wanted to say, but the time is very late.

National Maternity and Neonatal Investigation

Baroness Tyler of Enfield Excerpts

Monday 6th July 2026 Lords Chamber

[Baroness Merron (Lab)]

I am very sorry to hear of the loss the noble Lord experienced and of the deep effect on his family; I am sure he still lives with that feeling. I think the greatest gift we can give is to reduce the risk of something going in the way that it did in his family, and that we avoid all avoidable risks. That is exactly what this work is about, and that would be the right thing. For those who are affected, I mentioned the bereavement pathways. In terms of support that ICBs arrange across the country, there is a much greater awareness of the need to support people when they need it most.

[Baroness Tyler of Enfield (LD)]

My Lords, both the report of the noble Baroness, Lady Amos, and the Ockenden inquiry identified poor leadership cultures—defensive cultures, dismissive cultures and doctor-knows-best cultures. The noble Baroness already referred to the voices of women and their partners being ignored, particularly when they are complaining of pain. Is the Minister satisfied that the various important recommendations, provided they are implemented and seen through, will fundamentally address and change this culture?

[Baroness Merron (Lab)]

It is a challenge to take on a deep-rooted culture, but we are doing that and it will require action at every level, without doubt. The main thing, as the noble Baroness said, is putting women, babies and their families at the heart of care. This has not been the case. NHS England’s chief executive brought all trust chief executives to London on the day the report was published to discuss the urgent actions trusts can take on this and to focus on the next 100 days. All perinatal leadership teams have also completed a culture and leadership programme, which I believe will strengthen collaboration across maternity and neonatal services. Those are just two of the actions we will take, but this is absolutely fundamental to all the system changes.

Children’s and Young People’s Mental Health Services

Baroness Tyler of Enfield Excerpts

Thursday 2nd July 2026 Lords Chamber

Asked by

[Baroness Tyler of Enfield]

To ask His Majesty’s Government what assessment they have made of the Children’s Commissioner’s report Children’s and Young People’s Mental Health Services: 2024-25, published on 29 June.

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

My Lords, we welcome the report of the Children’s Commissioner. It highlights pressures on children and young people’s mental health services, including rising demand, long waits and the need for better support for those with neurodevelopmental and SEND needs. The findings will feed into our new cross-government mental health strategy, which will focus on prevention, earlier intervention and joined-up support.

[Baroness Tyler of Enfield (LD)]

I thank the Minister for her Answer. The Children’s Commissioner report certainly made plain that children’s mental health services are facing record levels of referrals. The Minister referred to the forthcoming mental health strategy; what we need to see is concrete action in relation to children and young people. Will the Minister reassure me that children and young people’s services will be a priority in the strategy, and will the strategy commit to narrowing the treatment gap for mental health support so that more young people with diagnosable need will be seen by the end of this Parliament?

[Baroness Merron (Lab)]

The mental health of children and young people is completely fundamental to the new strategy, which will cover all ages and be published later this year. But what really needs to be done, as I know the noble Baroness is aware, is to transform mental health care in this country, because the system currently responds too late, is not reducing waiting times and is allowing distress to escalate before intervention. The strategy will work to turn all that around, because we need that system-wide change.

Mental Health Bill [HL]

Baroness Tyler of Enfield Excerpts

Consideration of Commons amendments and / or reasons
Monday 24th November 2025 Lords Chamber

[Lord Pannick (CB)]

My Lords, I join with the noble Baroness, Lady Watkins, in welcoming government Amendment 12, which says:

“A registered care provider is to be regarded for the purposes of section 6(3)(b) of the Human Rights Act 1998 as exercising a function of a public nature in providing any of the services mentioned”.


I am particularly pleased to see that the Government and the other place accepted this point, because it reverses the effect of a decision of the Appellate Committee of this House in 2008, YL v Birmingham City Council, in which I was the unsuccessful counsel for the unfortunate applicant. At the time, I took comfort from the fact that, of the five members of the Appellate Committee, the two who dissented in favour of my client were the noble and learned Lord, Lord Bingham of Cornhill, and the noble and learned Baroness, Lady Hale, and I am very pleased that their approach has now been accepted by Parliament. The point was summarised by the noble and learned Baroness, Lady Hale. She said that it is a function of a public nature for the purposes of the Human Rights Act when the function is performed pursuant to statutory arrangements, when it is performed at public expense and when it is performed in the public interest. It has taken 17 years, but the law has got there in the end.

[Baroness Tyler of Enfield (LD)]

My Lords, I start by adding my thanks to the Minister for her extremely constructive engagement throughout the Bill and particularly in recent weeks, as we have discussed community treatment orders and strengthening measures to monitoring racial disparities. My noble friend Lord Scriven has already covered the former, and I simply want to say that I am very grateful for the steps that the noble Baroness has taken to strengthen those measures for monitoring. Looking at racial disparities was, after all, the underlying rationale for this piece of legislation, so I am very glad that we are now going to have monthly reporting that we can access through the database and the dashboard—that is very good news. We will most certainly be scrutinising that data very carefully on these Benches and drawing any areas of concern to the attention of the House.

Liberal Democrats welcome the Bill. It is long overdue as an important step in ensuring people’s dignity and human rights, but we also recognise that it comes amidst a very challenging landscape for mental health services more broadly. We all know the serious shortcomings in current mental health services. Throughout the process of scrutinising the Bill in both Houses, we have urged the Government to back calls to invest in community mental health services and to produce a clear, costed implementation plan with clear timescales. We consider that very important because our outstanding concern is that the Bill on its own does not include adequate measures to promote preventive and early intervention services to stop people reaching crisis point and all the issues that we have discussed during this passage of the Bill.

We have been very glad to contribute to the Bill. It constitutes the biggest piece of legislation on mental health in 40 years. In the same vein, it could be the case that we do not have another major piece of legislation for another 40 years. I hope that is not the case, but these Bills do not come along very often. That is why we are determined to push the Government to look beyond the relatively narrow scope that this Bill has offered, to include community-led preventive care rather than simply focusing on helping people as they reach crisis point.

It has been a very important piece of legislation. I would like to thank the Minister again for her extremely constructive engagement and the tone she has set throughout this Bill. I would like to thank all noble Lords, from these Benches and from all Benches, for their extremely well-considered and very expert and heartfelt contributions. Last of all, I would like to thank officials, the Bill team and Adam Bull in the Liberal Democrat Whips’ Office.

[Lord Kamall (Con)]

My Lords, I too start by thanking the Minister, her officials and her special adviser for their constructive engagement on the Bill. The Bill has been returned to us from the other place without the amendments made in this House. Obviously, I would have preferred it if those amendments had remained in the Bill, but I understand that the Government believe that they are not necessary.

Amendments 1 to 4, and 11, remove the amendment proposed by my noble friend Lady May of Maidenhead and tabled by me and my noble friend Lord Howe on Report, which would have allowed a wider range of people to undertake detention under Sections 2, 3 and 5 of the Mental Health Act. I thank my noble friend Lady May for giving specific examples of why that was called for.

I understand that there were two main concerns with those amendments. First, some were concerned about setting a precedent beyond the Bill for being detained by personnel who are not police officers. Secondly, some of the health professionals who would have been affected by this change felt that they had not been properly consulted. I am therefore grateful to the Minister and her officials for suggesting a consultation on whether these powers could be extended. It is good that we are going way beyond just this and having a wider consultation.

Amendment 6 removes Clause 35 from the Bill. It was inserted after a successful Division on Report and was moved by my noble friend Lord Howe. It was intended to ensure that those who are detained and given treatment for their mental health receive a proper debriefing after their discharge and that the system can learn and not repeat the same mistakes. My noble friend mentioned the experiences of young people who felt that they were not being listened to, but during our meeting with the Minister, she agreed to outline at the Dispatch Box how the Government would ensure that more is done to listen. We welcome the assurances she has given.

Another question we raised was on patients having a right to an advance choice document. We would of course have preferred that to be in the Bill, but we understand that Amendments 7 to 10 are a step in the right direction, and in fact the Government have said that there is not really much difference in practice between the wording in the Bill and the alternative wording that we suggested. Once again, I welcome the assurances, but we will pay close attention to make sure that ICBs and trusts are making people who should have the right to an ACD aware that they do have that right. I think that is something that many noble Lords agree on.

On Amendment 19D from my noble friend Lady Berridge, I understand that she had some concerns, which she was able to share with the Chamber, supported by other noble Lords. One was on the use of “or”, and there is some debate about whether we need “or” in the Bill to imply “or”. I am not a legal expert, but I hope that some assurance can be given there. I also hope that some of the other issues my noble friend mentioned can be resolved in further discussions between her and the department, and possibly either in the code of practice or in specific guidance—but also in discussions with the relevant health professionals who have raised the concerns with her.

One issue that I raised a number of times, and I thank noble Lords from the Lib Dem Benches also for raising it, is racial disparities. We have been speaking about racial disparities for far too long, and for far too long we have been given the answer, “It’s too complicated” or “The data is much more granular than you think”. I welcome the fact that the data will be published more frequently, but I hope that we take that data and make changes based on the evidence in it so that we are not looking at anecdotes or people’s prejudices but are tackling the real problem. For far too long, people of Afro-Caribbean descent have been detained, and no one has really got to the crux of the matter. I know that this is an issue which noble Lords from all Benches agree that we really need to hone in on and tackle.

Given all that, I again thank the Minister, her officials, her special adviser and others for their constructive approach. I also thank all noble Lords from all Benches. Many of us said that it was not a particularly political Bill, but it was an issue that we just wanted to get right. Given that, as the noble Baroness, Lady Tyler, said, this issue does not come up frequently enough and that it might be another 10 or 20 years before we discuss it again, and things move on and we are more aware of issues and understand some of these conditions in more detail, I thank all noble Lords and the Minister for the constructive way in which we have all worked together. Hopefully, we can now ensure that the Bill makes its way on to the statute book.

Care Quality Commission: Mental Health Care Waiting Times

Baroness Tyler of Enfield Excerpts

Thursday 8th May 2025 Lords Chamber

[Baroness Merron (Lab)]

I am aware of the very helpful report that my noble friend refers to. I acknowledge the challenges highlighted in that report and will certainly take into account the points it makes. I regularly meet with and listen to the sector on what we can do to improve outcomes and transform mental health services, and this report will of course feed into that.

[Baroness Tyler of Enfield (LD)]

My Lords, the NHS planning guidance for 2025-26 reduced the overall number of targets, including those for mental health, and the guidance given was of a fairly generalised and vague nature. In the absence of any such targets, what specific incentives are currently in the system for ICBs to prioritise improvements in mental health services?

[Baroness Merron (Lab)]

As the noble Baroness says, we reduced the number of targets on the basis of the recommendation by the noble Lord, Lord Darzi, that having so many targets was not delivering the results that we want. We have had to think boldly and innovatively. Since July 2023, NHS England has included waiting time metrics for referrals to urgent and community-based mental health services. I am looking at how we can drive improvements in quality and in the data to help services, particularly those with the most lengthy waits. I will also review the 2021-22 clinical review of standards to consider what else can be done to put mental health on a more equal footing, which it absolutely deserves.

Self-harm: Young People

Baroness Tyler of Enfield Excerpts

Monday 28th April 2025 Lords Chamber

[Baroness Merron (Lab)]

I definitely share my noble friend’s concern about what is a worrying trend, and I can confirm that I am aware of the research to which he refers. In addition to the suicide prevention strategy, we are providing access to a specialist mental health professional in every school in England. We are rolling out Young Futures hubs and recruiting 8,500 mental health workers, and we continue to fund and benefit from the multi-centre study of self-harm to inform the development of policy and clinical practice, in order to tackle the very real and serious problem that my noble friend describes.

[Baroness Tyler of Enfield (LD)]

My Lords, we know that self-harm is most common amongst 15 to 24 year-olds, particularly young women. As we have already heard, there are so many challenges in accessing the mental health support that young people need that often, they cannot get it before their mental health problems get worse. The Minister already referred to the rollout of Young Futures hubs. Can she tell the House when there will be such a hub in every local area, to ensure that young people can access the support they need at the earliest signs of emerging mental health problems?

[Baroness Merron (Lab)]

The noble Baroness is quite right that it is unacceptable that too many children and young people are not receiving the mental health care they need. Our determination to change that, as she says, is about rolling out Young Futures hubs in communities. We are at an early stage of developing the plans, and I very much look forward to continuing to work across government to deliver this and to updating your Lordships’ House.

Mental Health Bill [HL]

Baroness Tyler of Enfield Excerpts

3rd reading
Wednesday 23rd April 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, as the Minister has said, debating the passage of the Bill through your Lordships’ House has been a pleasure. We have seen a genuine spirit of constructive engagement with a Bill that we all acknowledge will help patients who encounter mental health services, as well as a cross-party desire to improve the Bill. This was not a particularly political Bill; we found alliances across political lines and did not play political games. We wanted to improve the Bill and make sure that patients receive the best possible care. That is a wonderful demonstration of the value of this House.

I extend my thanks to all Peers who took part. I also thank the members of the pre-legislative committee whom the Minister acknowledged. Like the Minister, I acknowledge my noble friend Lady May of Maidenhead, the former Prime Minister, who we have to thank for beginning the process that led to this Bill. My noble friend identified the issue of racial disparities in the use of community treatment orders and wanted to reduce the involvement of police where they are not needed. Even though my noble friend was unable to be in her place to speak to her amendments on Report, I am grateful to all noble Lords who supported them, and I am delighted that the House has decided that they should be inserted into the Bill. We look forward to how that will be debated in the other place.

It was also welcome to see the House rally behind my noble friend Lady Berridge’s amendment to ensure that the process for appointing nominated persons for patients under 16 aligns with the Children Act 1989. My noble friend was crystal clear that there has to be consistency between different Bills, and that we do not want people falling between Bills and into harm’s way. She highlighted this and gave some harrowing examples of what could happen if we do not align these Bills. We have to make sure that we align them as much as possible.

I also thank the noble Lord, Lord Scriven, and the noble Baroness, Lady Tyler, for their dedication to improving community treatment orders and addressing racial disparities. Noble Lords will remember that this is probably the issue that was closest to my heart, and we probed the Government heavily on it. There are still too many racial disparities. We understand that it is a complicated issue, but the Government assured the House that they are looking into the data around this. What do they know? What do they not know? How will they fill that gap and what will they do to address racial disparities? I hope that is something that all noble Lords can agree on.

Of course, I have to thank my noble friend Lord Howe for his stalwart support and advice on this Bill, and for his experience not only of parliamentary procedure but of previous iterations of this Bill. I appreciate his sagacity, and I am grateful whenever he agrees to work with me on Bills—sometimes to curb my schoolboy enthusiasm and keep me on the right path. I am grateful that he has agreed to work with me on the Tobacco and Vapes Bill, which your Lordships will debate later today.

I also thank the Minister—and of course her noble friend, the noble Lord, Lord Timpson—for taking time at the Dispatch Box, and for the fact that the Minister and her officials were always available to meet us to try to iron out some of the disagreements or find compromises. That is very much appreciated by all noble Lords in this House. I thank Ben, the special adviser in her office, for his input, and, in our office, our adviser Jamie Tucker, who was amazing in his understanding of the Bill.

I will end by mentioning a quote that was sent to me and my noble friend Lord Howe from the charity Blooming Change. On hearing that the House had voted in favour of my noble friend’s amendment on mandatory debriefing for mental health patients, a younger person told the charity:

“I genuinely for the longest time felt like I didn’t matter, to anyone or anything, that the universe didn’t need to hear my voice, that what I went through didn’t matter. It took so long to build my confidence and to find my voice … I’m glad I decided to use my experiences to fight for change and I’m so happy our words have made a difference. We will keep fighting for more changes, little by little”.


As the Bill now progresses to the other place, I hope all Members involved will heed those wise words.

[Baroness Tyler of Enfield (LD)]

My Lords, it has been a privilege to be involved in scrutinising and improving this vital Bill, for which we had waited so long. Our debates have been, rightly, exhaustive, and at times—again, quite rightly—passionate. I will make one general observation, which is a point that was made on a number of occasions throughout our deliberations. You get only one chance about every 15 years to reform and modernise mental health legislation, so it is really important to get it right and to include all the relevant issues before the ship sails. Some would like to have seen more fundamental fusion legislation between mental health and incapacity, but that was not on the table, so you work with what you have.

Mental Health Bill [HL]

Baroness Tyler of Enfield Excerpts

Report stage
Wednesday 2nd April 2025 Lords Chamber

Moved by

[Baroness Tyler of Enfield]

47: After Clause 51, insert the following new Clause—
“Mental Health CommissionerAfter section 142C of the Mental Health Act 1983, insert—“Mental Health Commissioner
142D Independent Mental Health Commissioner: establishment(1) There is to be an office known as the Office of the Mental Health Commissioner.(2) The Office in subsection (1) must be established by the Secretary of State three months after the day on which the Mental Health Act 2025 is passed.(3) The Office of the Mental Health Commissioner will be led by an individual appointed by the Secretary of State titled the “Independent Mental Health Commissioner”.(4) The role in subsection (3) is referred to as the “Mental Health Commissioner”.(5) The Mental Health Commissioner may appoint staff to the Office of the Mental Health Commissioner they consider necessary for assisting in the exercise of their functions in section 142E. 142E Functions of the Commissioner(1) The Mental Health Commissioner is responsible for overseeing the implementation and operability of functions discharged by relevant bodies and persons under the provisions of this Act, the Mental Health Act 1983, and the Mental Capacity Act 2025 particularly regarding the provision of treatment, care, and detention of people with a mental disorder.(2) The Mental Health Commissioner must publish an annual report on the use of functions discharged under this Act, which must assess—(a) the quality of mental health care treatment provided by relevant services;(b) the accessibility of mental health care treatment services;(c) the relationship between mental health and the criminal justice system;(d) inequalities of mental health care provision regarding protected characteristics under the Equality Act 2010;(e) the use and effectiveness of detention measures under this Act, including but not limited to Community Treatment Orders, for the purposes of therapeutic benefit outlined in section 1(2B);(f) challenges surrounding stigma of mental health conditions;(g) the accessibility of advice and support to mental health service users, their families and carers on their legal rights;(h) other issues deemed appropriate by the Mental Health Commissioner.(3) In fulfilling their duties under subsection (1), the Mental Health Commissioner may review, and monitor the operation of, arrangements falling within subsection (1), (2) and (3) for the purpose of ascertaining whether, and to what extent, the arrangements are effective in promoting the principles in section 118(2B) of this Act.(4) Subject to any directions from the Secretary of State, the Commissioner may take action necessary or expedient in connection for the purposes of their functions.(5) This may include—(a) collaborating with health services, public authorities, charitable organisations, and other relevant entities, including NHS bodies, the Care Quality Commission, and the Parliamentary and Health Service Ombudsman;(b) ensuring enforcement authorities and public bodies under the Mental Health Act 1983 have the necessary capacity and resources to adequately discharge duties under the Mental Health Act 1983 and this Act.142F Appointment, Tenure, and Remuneration of the Mental Health Commissioner(1) The Secretary of State may by regulation make provision for the appointment, tenure, removal, and general terms of appointment of the Mental Health Commissioner.(2) The Secretary of State may also by regulation determine the Commissioner’s remuneration, allowances, and pension entitlements.142G Examination of cases(1) The Secretary of State may, by regulations, make provision for the examination by the Mental Health Commissioner of the cases of those who are detained under this Act receiving treatment by authorised mental health care providers.(2) The Secretary of State may, by regulations, provide for the Office of the Mental Health Commissioner to access and examine relevant data on mental health treatment provision held by NHS England and any other authorities the Secretary of State considers appropriate.142H Regulations(1) Regulations under sections 142F and 142G are to be made by statutory instrument.””Member’s explanatory statement
This amendment establishes the office of the Mental Health Commissioner and makes provisions for relevant duties and responsibilities.

[Baroness Tyler of Enfield (LD)]

My Lords, Amendment 47 would establish a mental health commissioner for England. The role would fill a major gap in the operation of the Mental Health Act and the rights of people with mental health difficulties. I believe this role is essential in ensuring oversight and advocacy for people affected by the Mental Health Act.

Unlike existing bodies, the commissioner would have a strategic, cross-government focus working to promote mental health, tackle inequalities and be a powerful advocate for the rights and well-being of those living with mental health problems, who would finally have a voice at the top table. The commissioner would also play a vital role in the public sphere, tackling stigma and discrimination and championing policies that support good mental health across society. The commissioner would have the independence to comment on the implementation of the reformed Mental Health Act and any subsequent changes or issues that arise. International evidence highlights the impact such a role can play in improving outcomes.

I know concerns were raised in Committee that the commissioner would duplicate the CQC’s Mental Health Act responsibilities. I simply do not believe this is so. The CQC is an arm’s-length body that has a statutory responsibility to inspect and regulate health and care services and intervene in cases of abuse of people’s rights, and it has powers to tackle poor practice in providers. Its work is essential, but its ability to oversee implementation is limited and it absolutely does not have a policy advisory function. I welcome the announcement of a new chief inspector for mental health at the CQC, who will lead the inspection of mental health providers. It is long overdue. However, like the CQC, the new chief inspector will have no role to work across government to take a view on public health policies or their implementation and to speak publicly on them, so the roles of the new chief inspector and the commissioner in my amendment are separate and distinct.

The commissioner would complement the CQC in the same way as the Children’s Commissioner complements Ofsted. I was very pleased to hear that the Minister recently had a productive meeting with the Children’s Commissioner, including, as I understand it, a discussion on children and young people’s mental health. I look forward to hearing more about that. I am sure that the Minister understands the distinct role that the Children’s Commissioner has in championing the rights of children with mental illness and that it is separate from the role of Ofsted.

Finally, I know that some concerns have been raised about resources. I emphasise again, as I did in Committee, that I envisage the commissioner having a very small secretariat, similar perhaps to the Domestic Abuse Commissioner or the Victims’ Commissioner. I believe the latter has around 10 staff. Of course, the commissioner would prioritise their work sharply. For a small investment, I believe that the commissioner could transform the way government and public services support our mental health, bringing a deep understanding of mental health into the heart of government, with statutory authority and independence that will enable them to inform policy, support delivery and oversee progress. They can bring government departments together to make the best use of resources and advocate for mental health in the public sphere. I beg to move.

[Lord Bradley (Lab)]

My Lords, I will speak briefly to Amendment 47, so eloquently moved by the noble Baroness, Lady Tyler. As the House will know, the establishment of a mental health commissioner was a recommendation of the joint scrutiny committee on the Bill, of which I was a member, but, disappointingly, it was not included in the Bill. As I have said on a number of occasions, I believe that a commissioner could be a voice at a national level, promoting the interests of those who are detained or are likely to be detained under the Mental Health Act, together with the interests of their families and carers.

There will be a need for rigorous, robust and consistent oversight of the implementation of the Act, wider mental health policy issues and service development, particularly workforce capacity, over the next decade and beyond. The establishment of a mental health commissioner could ensure public confidence, transparency and accountability during that period.

However, since Committee, the landscape has shifted somewhat. First, throughout the passage of the Bill, as we have heard, the Minister has made the case that the CQC, as the regulator, already has responsibility for the range of activities proposed for a mental health commissioner. This view was recognised by the Official Opposition. I still have considerable doubts about it but, as we have heard, the CQC has now created the role of Chief Inspector of Mental Health, because it at last recognises the crucial importance of mental health services in supporting people to lead fuller, healthier lives, and the need for specialist expertise in regulating those services. The eminent doctor, Arun Chopra, has been appointed. I hope to meet him as soon as possible, to be clear about his role and the range of activities that he sees it as his role as regulator to undertake. I hope that may go some way towards allaying my concerns.

Secondly, and importantly, the Secretary of State, Wes Streeting, has stated that, in future, he is determined to be directly accountable to Parliament for the performance of the health service—obviously, including mental health. To achieve that, he wishes to reduce arm’s-length bodies. As we all know, he has already announced the abolition of NHS England. Clearly, that will lead to significant uncertainty during the reform process, and the establishment of a mental health commissioner at this time would be unlikely to land favourably. It is clear to me that primary legislation might be required, yet again, to implement the NHS reforms that the Secretary of State is advocating, so Parliament may have a further opportunity to consider the new architecture of the NHS and then determine whether to bring forward plans for, among other things, enhanced advocacy and oversight of the implementation of the Act, and to support the policy development that a mental health commissioner, as we have heard, could bring to the table.

In the meantime, I will continue to take every opportunity to hold the Government to account, as the Secretary of State has assured us he will welcome. The Secretary of State should be looking particularly at the implementation of this Act and the capacity of the service to deliver it in a timely way. I will be looking at further developments of mental health policy, particularly the interface between health and the criminal justice system in the future.

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[Baroness Merron (Lab)]

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

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

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

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

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

[Baroness Tyler of Enfield (LD)]

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

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

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

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Moved by

[Baroness Tyler of Enfield]

48: After Clause 51, insert the following new Clause—
“Review and reporting on inequalities in Mental Health Act Measures(1) As soon as reasonably practicable after the end of each calendar year, the Secretary of State or appropriate national authority must conduct a review, in consultation with relevant bodies with commissioning functions, on the use of treatment and detention provisions contained in the Mental Health Act 1983, broken down by race and other demographic information.(2) Having conducted a review under subsection (1), the Secretary of State or appropriate national authority must publish a report on the progress made in reducing inequalities in treatment outcomes and the use of detention under the Mental Health Act 1983 on people who have protected characteristics under the Equality Act 2010.(3) In this section “the appropriate national authority” means—(a) in relation to services or unit whose area is in England, the Secretary of State;(b) in relation to units or services whose area is in Wales, the Welsh Ministers.”Member’s explanatory statement
This amendment requires the Secretary of State or Welsh Ministers to review and report annually on the use of treatment and detention measures under the Mental Health Act 1983, analysing data by race and other demographics to assess progress in reducing inequalities for those with protected characteristics under the Equality Act 2010.

[Baroness Tyler of Enfield (LD)]

My Lords, Amendments 48 and 49 are in my name. I thank the noble Baroness, Lady Bennett, for adding her name to Amendment 49.

As debated throughout the passage of the Bill, a primary driver of the review into the Mental Health Act was the shocking racial injustices in the use of that Act. The figures are well known to us: black people are disproportionately more likely to be detained and put on a CTO, and experiences and outcomes for people from racialised communities are, on average, worse. One of the main policy objectives set out in the Bill’s impact assessment is to

“reduce racial disparities under the MHA and promote equality”.

That is great but, given that, I have found it surprising from the outset that race and racial disparity were not mentioned anywhere in the Bill or the Explanatory Notes.

Instead, there has been an expectation that non-legislative programmes—in particular, the patient and carer race equality framework, which is a contractual arrangement—and some of the Bill’s broader reforms will reduce racial disparities without specific legislative requirements. I was grateful to the Minister for organising a helpful recent round table on reducing racial disparities. I learned a lot about the operation of the PCREF, if I might call it that; I will return to it shortly.

I believe there is currently insufficient collection and reporting of data on the experiences and outcomes of people from racialised communities under the Act. That in turn hinders the ability to scrutinise progress being made in reducing racial disparities. I know from our deliberations on Monday that further thought is being given to this and that new research is being commissioned. I very much welcome that, so what would my amendments do?

In brief, my Amendment 48 would require the Secretary of State and Welsh Ministers

“to review and report annually on the use of treatment and detention measures”,

broken down by detected characteristics. This would enable us to understand whether these reforms are fulfilling their intended purpose of bringing down inequalities and to identify any further action needed. However, I firmly believe that this needs to be accompanied by Amendment 49, which would introduce a new responsible person role at hospital level in mental health units to tackle and report on racial and other inequalities, as recommended by the Joint Committee.

The Minister has expressed concerns that a responsible person role may duplicate existing roles and duties, such as those under the Equality Act. I do not believe that will be the case. Where there are people performing similar roles, they can take this on but, in many places, local PCREF leads do not exist. Where they do, they can take on the responsible persons role and that is absolutely fine. I think this role would actively assist providers in complying with PCREF and their Equality Act duties. It would also help to drive implementation of other measures in the Bill, such as advance choice documents and opt-out advocacy. These important measures are much more likely to succeed if someone is clearly tasked with ensuring that the mental health unit implements them, everyone knows who is in charge and who is accountable.

There is a model for the use of a responsible person at unit level, in the Mental Health Units (Use of Force) Act 2018. Under that legislation, the role is accountable for ensuring that the requirements of the Act are carried out. It is a senior role which may be carried out by an existing member of staff, such as a medical director or director of nursing. That would be a good model to follow. Giving an existing senior clinician with the necessary clout the responsibility to make things happen and creating clear accountability would really help to bring down disparities at local level.

The scope of the PCREF, which is NHS England’s anti-racism framework, is rightly much broader than the Mental Health Act. The responsible person in my amendment would be accountable for ensuring that the voices and interests of detained patients and their carers are properly reflected in the PCREF.

Finally, I was very grateful to the Minister for our recent correspondence following the helpful round table I referred to. I was very struck by the acknowledgement at that event of the big difference that a responsible person could make in enabling the patient and carer race equality framework to reduce both racism and racial inequalities in the way the legislation operates. As the Minister knows, I have made the—hopefully—helpful suggestion that some form of pilot of the responsible person role could considered at an appropriate time when the PCREF has bedded down and with some idea of how effective, or otherwise, it might be. Any assurances the Minister could provide would be much appreciated. I beg to move.

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is a pleasure to follow the noble Baroness, Lady Tyler. I have attached my name to the noble Baroness’s Amendment 49. As the noble Baroness said, like Amendment 48 it addresses one of the primary reasons for reviewing the Mental Health Act in the first place. Black people are over 3.5 times more likely to be detained under the Mental Health Act than white people, and over seven times more likely to be placed on a community treatment order. Their experiences and outcomes are worse. All of those are facts. As the noble Baroness, Lady Tyler, said, the Bill somehow does not seem to be addressing that. We are taking an overall systemic view but not addressing the issues of a particular population. The reason I chose to sign Amendment 49—we are going to come shortly to the amendment in the name of the noble Lord, Lord Stevens, looking at the resources being put into the Mental Health Act—is that this is another way of putting resources into what everyone agrees is a crucial issue. This is a different way of allocating resources.

The noble Baroness, Lady Tyler, has made the case that PCREF is not the same thing. The Care Quality Commission does not have the same kind of situation. We are talking about people at a local trust level here; that is where the responsible person would be. As the noble Baroness said, if there is already someone, because of local arrangements, fulfilling this role, they can simply adopt this along the way. It does not have to be any kind of duplication. I note that the campaign group Mind very strongly backs this amendment. It delivers where we started from on this whole Bill.

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[Baroness Merron (Lab)]

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

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

[Baroness Tyler of Enfield (LD)]

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

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

Amendment 48 withdrawn.

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Moved by

[Baroness Tyler of Enfield]

50: After Clause 51, insert the following new Clause—
“Workforce sufficiency assessment by Integrated Care BoardsAfter section 142C of the Mental Health Act 1983 (inserted by section 51 of this Act), insert—“142D Workforce sufficiency assessment by Integrated Care Boards(1) Each Integrated Care Board must conduct a workforce sufficiency assessment every two years to evaluate whether it has sufficient workforce resources to deliver services under this Act effectively. (2) The assessment may include—(a) an analysis of current workforce levels across all relevant service areas;(b) identification of workforce shortfalls;(c) an evaluation of the impact of staff shortages on patient care and service delivery;(d) proposals to address workforce challenges.(3) Integrated Care Boards may consult any relevant personnel or organisations they deem appropriate when conducting the assessment.(4) Each Integrated Care Board must publish a report outlining its findings upon completing the assessment.(5) The first reports must be published 12 months after the day on which the Mental Health Act 2025 is passed.””Member’s explanatory statement
The amendment requires Integrated Care Boards to produce a biennial report assessing workforce sufficiency, identifying shortages, and proposing measures to address workforce challenges in delivering services.

[Baroness Tyler of Enfield (LD)]

It is funny how these amendment groupings work, is it not? I will speak to my Amendment 50 and say a few comments on Amendment 59 in the name of the noble Lord, Lord Stevens, to which my name is attached.

We have talked a lot throughout the passage of this Bill, and rightly so, about the importance of how it is implemented and in particular about ensuring that sufficient resources are available to allow a much-needed expansion of community mental health services. To be blunt, unless this happens, the Bill just will not be implemented. To put this into context, those waiting the longest for elective community mental health care—both adults and children—have waited two years, which is twice as long as those waiting for elective physical health care. Parity is still a long way off.

I was very grateful to the Minister for sharing the Government’s implementation plan and for arranging a helpful discussion with her and officials.

My Amendment 50 would require integrated care boards to produce a biennial report assessing workforce sufficiency, identifying shortages and producing measures to address workforce challenges in delivering these services. We all understand that it will take time to enact the Bill’s provisions and that systems will take time to build capacity, including training of an expanded work- force—particularly given existing workforce challenges. In Committee, I talked about the workforce impacts of the Bill, drawing on figures and research from the Royal College of Psychiatrists. I will not repeat those figures, save to say that NHS England set a target back in 2016 to have more than 1,040 consultant psychiatrists in post in England by last year. Based on these targets, as of last year, there was still a shortfall of 769, so we still have a long way to go. Of course, the mental health workforce goes considerably wider than consultants.

I turn to Amendment 59 in the name of the noble Lord, Lord Stevens, to which I have added my name and which we very strongly support on these Benches. This amendment would ensure that mental health funding is not cut as a share of overall health service funding until this Bill is fully implemented. Indeed, it is vital, given the pressures on public finances, including on the overall health system and the pressures that they pose to mental health spending. Critically, the amendment would not tie the Government’s hands in whatever decisions they make about the overall level of NHS spending.

One reason why I support this so strongly is because the Written Statement from the Secretary of State on 27 March on the amount and share of spend on mental health was, frankly, not reassuring, with mental health spending expected to go down as a proportion of overall NHS spend this year and a forecast for similar next year. I know that it was small amounts, but this could be part of a trend. It just reinforces the point that mental health spending and parity of esteem are not currently sufficiently protected, which I believe underlines the need for legislative cover. Therefore, if the noble Lord, Lord Stevens, is minded to test the opinion of the House, we will certainly support him.

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[Baroness Merron (Lab)]

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

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

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

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

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

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

[Baroness Tyler of Enfield (LD)]

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

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

Amendment 50 withdrawn.