Mental Health Bill [HL]

Debate between Baroness Tyler of Enfield and Lord Kamall

Report stage
Monday 31st March 2025 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I will very briefly speak in support of this very important set of amendments. As my noble friend Lord Scriven set out on Amendment 11, which I very strongly support, the case for having some conditionality around community treatment orders is overwhelming, including making them time limited and having a second doctor’s certification to confirm their therapeutic benefit. Both are very hard to argue against. They get the right balance between, as we heard in earlier stages, those who want to get rid of the orders altogether and those who feel that we need to tighten up the conditions. The other two review amendments are also very important.

Finally, we need to remind ourselves, as we did at Second Reading and in Committee, that black people are seven times more likely to be on a community treatment order than other members of the population. That is why this is so important.

[Lord Kamall (Con)]

My Lords, I thank the noble Lord, Lord Scriven, for the excellent way he introduced his Amendment 11. I fully support everything that he said.

The suitability of community treatment orders is an issue that has obviously featured heavily in the discussions on the Bill so far. I think that many of us came to the debates on the Bill, having read the Joint Committee’s pre-legislative scrutiny report, thinking that we were going to support the abolition of community treatment orders or be very sympathetic to that idea. However, two contributions gave us a reason to pause and think. One was the personal story from the noble Baroness, Lady Parminter; the other was hearing the noble Baroness, Lady Barker, say that she previously believed that they should be abolished before realising that they are entirely appropriate for a small number of situations or cases. In fact, given that one of the principles of the Bill is imposing the least amount of restriction, maybe they are the least restrictive solution for some incidents.

Having said that, very serious concerns obviously remain about the use of community treatment orders in their current form. Other noble Lords and I spoke in Committee about the overrepresentation of black males, which is what my Amendment 62 intends to address. It was a shame that the deliberations on this issue came so late at night, but I thank the Minister and her officials for their engagement. I asked three simple questions: what do we know about why black people are disproportionately detained? What do we not know? What research and work are we conducting—I know this sounds like a PhD research thesis seeking to generate the research questions so that someone can go from an MPhil to their PhD—and what is the gap in research to generate the questions for the primary research?

I was very reassured by the responses from the Minister and her officials that they take this seriously. They set out in detail the work that they are doing. In fact, the Minister put a lot of that in a letter to me. It would be unfair of me to ask her to read out precisely what is in that letter, because we would be here for quite a few hours, but can she share some of those assurances with the House? It would be very helpful for other noble Lords to understand why, given that letter, I have decided that I will not push my amendment to a vote.

As I said, the noble Lord, Lord Scriven, has struck the right balance. The amendment acknowledges that there are issues with CTOs and allows for their continued use, under restrictions. It is really important that, in every case, there is a review, and 12 months would seem an appropriate time for that review, rather than cases just being forgotten about, people being caught up in other casework or cases falling behind the filing cabinet—if there was another analogy I could use, I would. If the noble Lord, Lord Scriven, decides to divide the House, these Benches will support him.

I look forward to hearing some of the assurances the Minister gave to me and others on racial disparities. I hope also that she can address the concerns of the noble Lord, Lord Scriven.

Mental Health Bill [HL]

Debate between Baroness Tyler of Enfield and Lord Kamall

Committee stage
Monday 24th February 2025 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I had not intended to come in on this group, but, having just heard the very powerful—and, in places, very alarming and harrowing—speech from the noble Baroness, Lady Fox, I will just ask the Minister whether he can explain what plans the Government have to assess and evaluate the impact of the provisions of the future Act on prisons and the criminal justice system, even if they are not planning a formal review. We need to know how the impact will be assessed.

[Lord Kamall (Con)]

My Lords, during the passage of this Bill, both the noble Baroness, Lady Fox, and the noble Lord, Lord Bradley, who is not in his place, have spoken passionately about people with mental health issues in prison. The noble Baroness, Lady Fox, referred to Valdo Calocane, and I know that the Government have instigated an inquiry. That particular case was the motivation for Amendments 160BA and 160BB in a later group, to which my noble friend Lord Howe will speak.

During the earlier debates on this, both at Second Reading and in Committee, I was particularly struck by the remarks of the noble Baroness, Lady Fox, on Chief Inspector Charlie Taylor’s graphic description of seriously mentally ill people in prisons being akin to a Victorian nightmare. After that debate, I read some of what Charlie Taylor had said, particularly about his visit in 2022 to Eastwood Park, where he witnessed

“bloodstains on the floor and scratch marks on the walls—evidence of the levels of distress of the women being held there”.

The noble Baroness, Lady Fox, also told the Committee about the experience of prison staff, saying that one of the most difficult things is the danger that prisoners with mental health issues pose to themselves, other prisoners and staff. In fact, Charlie Taylor gave an example of an incident when staff were

“unable to stop one inmate from repeatedly running into a brick wall due to a lack of suitable training”.

These are very important issues that the noble Baroness and other noble Lords are raising.

Given all this and its importance—I know that one of the reasons the Minister was appointed to his position was his experience and passion for prison reform—it seems reasonable to ask the Secretary of State to publish a review of the impact of this Act on prisons and to assess whether it provides for adequate support for ongoing treatment and care in those settings, including adequate staff training. I am sure this will be of help not only to the Secretary of State for the Department of Health and Social Care but to the Ministry of Justice. I look forward to the Minister’s response.

--- Later in debate ---

[Baroness Tyler of Enfield (LD)]

My Lords, there has been discussion throughout Committee about whether this Bill and our deliberations should stick strictly to detention under the Act or range wider. I know that there are different views on this issue. I have said consistently throughout our debates that we need to see what more we can do to prevent people reaching the point where the only option is being forcibly detained.

I feel that a key omission is a power around prevention. Given the cost of statutory in-patient admissions under the mental health legislation, and the stated intention of the Secretary of State to reduce hospitalisation through prevention, I find this surprising. Therefore, I have brought forward a simple amendment that would give relevant authorities the power to promote mental ill-health prevention in their communities, while of course being realistic about current financial realities.

My Amendment 160B seeks to explicitly grant relevant bodies, including integrated care boards, public health bodies and local health boards in Wales, the power to promote mental ill-health prevention within their communities. It would also empower organisations such as social care and the voluntary sector to take proactive steps in reducing the likelihood of individuals reaching crisis point and requiring detention under the Act.

I was pleased recently to have the opportunity to discuss this with the Approved Mental Health Professional Leads Network, which is very much involved in this. It expressed its support for such an approach. I think we all understand that the causes of mental health issues are complex and can be as much around societal issues, such as employment, housing and poverty, as clinical issues. That is clearly recognised in the AMHP’s role, which acknowledges that while a clinical perspective is always appropriate, other perspectives can be equally valuable. As was explained to me, at the core of the approved mental health professional’s role is a responsibility to explore less restrictive alternatives to detention for individuals in crisis.

As has been quoted a number of times in this Chamber, recently the Secretary of State said that the Government will publish a 10-year plan early next year setting out how they will deliver three big shifts in the focus of the NHS,

“from hospital to community, from analogue to digital, and from sickness to prevention”.

I see this legislation, and indeed this amendment, as an opportunity to make a reality of that statement in relation to mental health. While there will always need to be provision for statutory interventions for those who present a severe risk to themselves or others, it is surprising to me that, in this journey from hospital to community and sickness to prevention, there is no explicit mention of the promotion of good mental health within the Bill.

There is plenty of evidence of the links between prevention and reducing detention. I was going to give some examples, but the hour is late and noble Lords will be pleased to hear that I am not going to. There are also plenty of examples of alternative approaches to detention, such as crisis cafes and safe spaces, community crisis response teams, mobile mental health and social care professionals who respond to individuals in crisis, peer support networks, sanctuaries and respite services. All these have been shown to be effective in reducing the need for hospital admissions.

To conclude, by formally giving relevant bodies the power—it is a power, not a duty—to promote mental ill-health prevention, this amendment encourages a proactive rather than a reactive approach to mental health care and support, thereby, I hope, reducing reliance on crisis interventions, including involuntary detention. I beg to move.

[Lord Kamall (Con)]

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

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

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

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

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

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

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


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

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

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

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

“evidence based preventive and promotional action to support”

population mental health and well-being.

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

Mental Health Bill [HL]

Debate between Baroness Tyler of Enfield and Lord Kamall

Committee stage
Monday 27th January 2025 Lords Chamber

[Baroness Tyler of Enfield (LD)]

Just the 16. Anyway, it is a long time to wait.

The amendments aiming to make it clear, as the noble Lord said, when the clock starts ticking are really important, so that there is real accountability injected into the system. Often, when things go wrong it is where no one really feels responsible for something, so it does not happen. I will also be interested to hear what the “exceptional circumstances” do and do not include—I hope we will get some examples—because if they include just things such as shortage of staff or beds, we will not get very far at all, given the current state of mental health beds.

I understand the rationale behind the amendments tabled by the noble Lord, Lord Stevens; the reciprocity is a really important point to make. I just have slight concerns that we might be saying that this cannot happen in the way that the noble Lord, Lord Bradley, wanted to see, because we know that we have not got the scarce and specialist beds. They are just not available; it is very important to be practical about it.

It comes to the heart of the matter of this whole Bill: we know that, unless proper resource is put into the implementation of the Bill, it is not going to work at all. We know that, with mental health provision, particularly a secure unit, particularly with the state of the estate, the shortage of staff and all of that, there has to be wholesale investment in it for these things to work. I think the time has come. I simply add my voice to others to say that I hope the noble Lord practises patience—but I think he has waited long enough so I hope his patience will not be tested any longer.

[Lord Kamall (Con)]

My Lords, I thank all noble Lords who spoke to the amendments. I also thank the Government for allowing the Minister for Prisons, Probation and Reducing Reoffending to reply to this group. That is very much welcomed by the Committee. I think it was the noble Lord’s father who once said, “Kindness is good for business”. In this case, he might find that kindness is good for his noble friend the Minister. Given how hard she has been working on the Bill, I think she deserves some respite, so I am sure that that is very welcome.

So far, we have debated the importance of limiting detentions for those with autism or learning disabilities without co-occurring mental disorders. We have also debated the community treatment orders. But until now, we have not covered the provisions of the Bill relating to this new statutory 28-day time-limited period for transfers from prisons to hospitals. As the noble Lord, Lord Bradley, has said, he has been very patient. Therefore, the Government enshrining this target in law is welcome. Unfortunately, progress towards the goal of 28 days, as set out in the 2021 guidance and the White Paper, has been slower than anticipated.

His Majesty’s Inspectorate of Prisons, in its 2024 report The Long Wait—I am sure the noble Lord is aware of this—said that

“people linger in prison for weeks, often months and even, in the worst cases, for more than a year waiting for their transfer to be completed”.

Unfortunately, even though the 28-day guidance was there from 2022-23, only 15% of patients in that period were transferred to hospital within that timeframe. Sadly, the average wait was 85 days, and one prisoner was identified as waiting 462 days for transfer to hospital.

These Benches welcome the 28-day limit being put on a statutory footing, but, as other noble Lords have said—not only on this group of amendments but on others—once again, there is an issue of implementation here. Just because it is in legislation does not mean it will deliver the improvements that are necessary.

The noble Lord’s colleague—the noble Baroness, Lady Merron—has been very candid with noble Lords, saying that not everything in the Bill will be delivered now, and that there is a 10-year timetable for implementation. Given that, will the Minister say, at this stage, whether the 28-day limit is an aspiration or something that could be delivered immediately? If, at this stage, it is an aspiration and—understandably so—awaiting future spending reviews, is he able to give an indicative timeframe? Is the hope for the next 12 months, the next five years or, perhaps, up to 10 years? That information would be very welcome to noble Lords. Many noble Lords have been asking this throughout this debate. We understand that not everything is going to be solved overnight, but it would be good if we could have as much information as possible on the Government’s intentions and aspirations, including indicative timetables, where they are possible. We also understand that not everything is going to be clearly tagged at this stage.

Another finding from the prison inspectorate’s report was that there were serious flaws with the data held on patients who were awaiting transfer. I understand that there is no publicly available data describing the access and waiting times for beds. The Minister might be able to correct me on that. Some of the data on the numbers of prisoners awaiting transfer obtained from providers had significant gaps, due to a lack of consistent and accurate reporting, and some data contained errors and unreliability. This might also impact on Amendments 97 and 98 from the noble Lord, Lord Stevens.

The noble Baroness, Lady Merron, may well tire of hearing me repeat the importance of collecting accurate and complete data, but, as I and many other noble Lords have said on many occasions, we really cannot solve many of the problems we face without data that is as accurate and timely as possible. Therefore, I urge both Ministers to take up the issue of data reporting for patients awaiting transfer from prison to hospital with their respective departments.

Turning to Amendment 96C in the name of the noble Lord, Lord Bradley, which creates an accountable person who will be appointed to oversee the transfer process and ensure that the statutory 28-day limit is completed, I think this, once again, speaks to the point of implementation. This could be a sensible way of holding providers to account and working with them to address the shortcomings in patient transfers. Given the Government’s 10-year timeframe for implementation, noble Lords have raised the importance of oversight and accountability. Therefore, in the remarks from the Minister and in any subsequent letter, I hope that the Government will be able to address the issue of implementation and to give an indicative timetable. I look forward to the Minister’s response.

Mental Health Bill [HL]

Debate between Baroness Tyler of Enfield and Lord Kamall

Committee stage
Wednesday 22nd January 2025 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I thank the noble Baroness for that response. One thing we can all agree on from this discussion is that these are complex issues and people sometimes have rather different understandings of what certain things might say or mean.

Having said that, I would just like to say where I think we are on the two issues. First, on advanced decisions, I have a strong view that children and young people aged 16 and 17 should have choices that are made available to adults extended to them. As I think the noble Baroness, Lady Bennett, said, it is about having a sense of agency and autonomy and feeling that their wishes and feelings are being respected. It may be that I did not draft it very well, but I was not suggesting that everyone was going to be forced to do it. It is there as an option, and that is a really important point that possibly did not come out sufficiently in the debate. The fault for that is mine. It may be that the approach that the noble Earl, Lord Howe, was suggesting is a better way forward. I do not know; I do not mind. I just feel that, because to me this is so fundamental and a question of human rights, we will need to return to this on Report.

I turn with some trepidation now to the statutory competence test for under-16s. I have been accused of being too cautious. That is fine. I understand where noble Lords were coming from. I did not say it when I introduced it, because I thought it would be a bit to odd to say it, but I was seeing my amendment as a bit of a backstop. In other words, if the Government are not minded to accept that recommendation, at least something would happen and at least there would be some sort of progress. As I said, I was very sympathetic to the test and the way that the noble Lord, Lord Meston, set it out. It had a fair amount of support, of course, across the Chamber, but the debate also showed that there are still some quite tricky issues that need to be teased out. I do not think it was quite as clear-cut as perhaps was being suggested, not least about issues around the consistency or otherwise of the application of Gillick.

It may be that, again, I did not get the wording right when I talked about a “review”. I accept that. Reviews can be kicked into the long grass and you never see anything again. But I thought the idea of a consultation was very important and, in fact, I think it would be quite difficult, having listened to this debate carefully, to move straight to having something in the Bill without having some sort of consultation first. It might be that you would want to take some sort of powers that would enable such a thing to be put in place after that consultation had happened, but to me it just felt that some issues still needed to be teased out.

Perhaps my initial amendment was not completely ludicrous, but it has been a really good and interesting debate—

[Lord Kamall (Con)]

Probing.

Draft Mental Health Bill

Debate between Baroness Tyler of Enfield and Lord Kamall

Tuesday 28th June 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Lord makes an incredibly important point. We have seen the impact that the pandemic has had on mental health across all age groups. During the Health and Care Bill, the noble Lord and many others raised the issue of parity between mental health and physical health, and I thank him for that. That brought home that the current legislation is out of date, which is why we really need to update it. I also thank noble Lords who have spoken so far for agreeing that this is not a party-political issue at all. We all want to address this issue, and maybe the issue of funding will come up. The Government remain committed to achieving parity between mental and physical health services to reduce inequalities. We are making good progress; investment in NHS mental health services continues to increase each year, from almost £11 billion in 2015-16 to £14.3 billion in 2020-21. We expect all current CCGs—and ICBs once operational —to continue to meet the mental health standard, and we have made a number of amendments. We are investing more than £400 million over the next four years to eradicate mental health dormitories. Clearly, as we go through the Bill, there will be financial implications, which will be considered as we debate it. I cannot give a clear pledge on which measures will be implemented until we have seen the Bill. Clearly, however, we understand that a lot of this is long overdue, so the quicker we can get this done and come to an agreement satisfactory to all sides of the House, the sooner we can get on with implementing it.

[Baroness Tyler of Enfield (LD)]

My Lords, I welcome many of the proposals contained in the draft Bill, particularly those that give people affected by the Bill more say over their treatment and care. However, as others have said, the Bill is currently worryingly silent on workforce issues, and I think we all agree that they will be critical to the successful implementation of any reforms. My specific question to the Minister is: what assurances can he give that children and young people aged 18 and under will benefit from the reforms at least as much as adults and, specifically, will they be able to access the same treatment safeguards as adults?

[Lord Kamall (Con)]

When I was having initial discussions on the various parts of the Bill, children and young people’s mental health clearly came up. The statistics are staggering. Some 420,000 children and young people were treated through NHS-commissioned mental health services in 2021. That is an increase of 95,000 in just a few years. That is still without us being aware of everyone who needs access to the system, or young people and their parents and families being aware of what support is available.

We are continuing to increase investment into mental health services by at least £2.3 billion a year by 2023-24, as set out in the NHS Long Term Plan. There is also the extra money in response to the pandemic, which saw extra demand. We have 287 mental health support teams in place in around 4,700 schools and colleges across the country but, once again, more needs to be done. It is one of those issues where demand outstrips supply.

We now have mental health support teams covering 26% of the country a year earlier than planned, but we hope to increase this progressively over the years so that as many schools as possible are covered. We have delivered 7 million well-being for education recovery programmes. We understand the tensions and workforce issues that will inevitably arise. The Health Education England review and the Government’s strategic review are considering all the changes in healthcare overall; all the technologies and ways of delivering services; and the change from secondary to primary and down to the community. We are working out in the response what workforce we need for each of those changes.

Mental Health Services for Rough Sleepers

Debate between Baroness Tyler of Enfield and Lord Kamall

Monday 21st March 2022 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, the most common health problems among homeless people are substance abuse, as the Minister just mentioned, and mental health problems; often it is a combination of the two. Given this correlation, can the Minister say what the Government are doing to reconnect addiction services with health services in order to treat homeless people with multiple health problems? Does the Minister agree that specialist addiction services should be jointly commissioned by the NHS and local authorities to ensure full integration?

[Lord Kamall (Con)]

Like many other noble Lords, the noble Baroness has raised a very important aspect of this issue. She is absolutely right that people with drug addiction often have physical and mental health needs as well. Mental health problems and trauma are often central to an individual’s dependence on drugs, alcohol or other forms of abuse. As set out in the drugs strategy, we are working with NHS England to ensure that there is joined-up service provision between specialist mental health services and substance misuse services for people with co-occurring issues, including those who are experiencing rough sleeping. We are also going to make sure that the next phase of integrated care system development includes leadership on drugs and alcohol to integrate both physical and mental healthcare and substance misuse services.

Vaccination: Condition of Deployment

Debate between Baroness Tyler of Enfield and Lord Kamall

Thursday 3rd February 2022 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for his question and for his longer-term engagement with me on this issue. I assure him that we are keeping this under constant review. The evidence changes. We are aware that new variants will arise, as is natural with any virus. Given the replication factor, when the virus replicates, there will be some imperfect replications and so there will be variants. That is just part of the virus spreading. As my noble friend acknowledges, we cannot give an absolute guarantee that there will be no new variants, but we are keeping an eye on all the variants and their continued transmission, along with the tools that we are using to protect workers, staff and everyone, to make sure that we are continuing to protect people as best as possible.

[Baroness Tyler of Enfield (LD)]

My Lords, I was pleased to hear the Minister say just now that some care homes will choose to keep this as a condition of employment because of the reassurance that it gives to both the relatives and the residents. In this increasingly fractious debate on mandatory vaccinations, one voice entirely missing has been that of patients, social-care users and care home residents on what they want. Could the Minister tell me, first, what consideration in the decision to change the policy was given to the wishes of patients and residents? Secondly, will patient-voice groups or relatives’ groups be included in the consultation referred to by the Minister? Thirdly, what will be the position of patients who, due to their own vulnerabilities, actually do not want to be treated by staff who, despite being given every opportunity, have chosen not to get vaccinated?

[Lord Kamall (Con)]

I thank the noble Baroness for raising that point. It is really important to note that, when engaging in debates such as this, it is sometimes easy to forget patients, and we should not do that. The health service should be all about patients; it should be patient-centred. I understand the concerns. One of the reasons that we originally introduced VCOD, particularly for care homes and then more widely, was that patients were very concerned and relatives of patients were concerned about their loved ones—they were terrified, given the early outbreaks that we saw in care homes. On the particular consultation, I am afraid that I do not have the information with me, but I will commit to write to the noble Baroness.

Adult Social Care

Debate between Baroness Tyler of Enfield and Lord Kamall

Thursday 2nd December 2021 Lords Chamber

[Lord Kamall (Con)]

I know that the noble Lord has been a champion in this area. We have been quite clear that, as we go forward, a number of issues have to be understood. For example, you cannot say that all unpaid carers are the same. They all have different needs: some can work and some cannot work; some can spend a couple of hours working and share their care duties with others; there are sole carers; some are elderly and some are younger. We want all the different partners to come together to discuss individual needs—including respite for carers, to rest and recharge—and to look at their financial situations. We have laid out that those who are not working may be eligible for other benefits on top of the care allowance that they get. We are exploring this. It is a process of discovery and we want to ensure that it works. We have therefore set out the vision and the three-year commitment.

[Baroness Tyler of Enfield (LD)]

My Lords, I would like to pursue the points that were raised a minute ago by the noble Baronesses, Lady Fox and Lady Watkins. Despite the welcome long-term aspirations in the White Paper, the reality is that the chronic workforce shortages in social care are getting worse, with uncompetitive pay being the main culprit. If Covid surges this winter because of the new variant, these workforce problems will be magnified, with potentially disastrous consequences. There are similar concerns with unpaid carers, as the noble Lord, Lord Dubs, has just said. With no new resources from the new levy coming on stream until October 2023, and all the fragilities that I have just described, what are the Government going to do to address the pay and retention issues now, over this winter?

[Lord Kamall (Con)]

The Government have been listening to the workforce and understand its pressures. We recognise that this is the vision, and that we need to look also at the short-term issues. We announced £162.5 million for the workforce recruitment retention fund, and the new Made with Care scheme to recruit social workers and to send a message that social work can be a rewarding career. We are talking to different bodies, including the Department for Education, about how we increase professionalisation. We have also increased the national living wage, meaning that many of the lowest-paid workers will be paid more. We are investing at least half a billion pounds in supporting the development and well-being of the social care workforce, including an investment in knowledge, skills, and well-being. We will work with partners to set the conditions for the professionalisation over a longer period. We cannot do this immediately; we want to consult the education sector and care and social care experts, to give recognition. That will be a precursor to making progress on pay.

Ambulance Response Times

Debate between Baroness Tyler of Enfield and Lord Kamall

Wednesday 1st December 2021 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Lord for raising that point and making people aware of the challenges in Northern Ireland. As he will be aware, health is a devolved issue, but we are very much aware of the challenges in all four of the devolved Administrations. If he would write to me with extra information, I should be happy to pass it on.

[Baroness Tyler of Enfield (LD)]

My Lords, it is estimated that nationally, a quarter of patients in beds are clinically ready to leave hospital but cannot do so due to problems of discharge—particularly a lack of available care in the community. With fewer available beds, ambulances cannot discharge patients to a bed, leading to a lack of ambulances and paramedics available to deal with other emergencies. What plans do the Government have to deal urgently with the problem of discharge to help the NHS get through the winter?

[Lord Kamall (Con)]

All noble Lords have raised important points about the pressures on different parts of the system. In taking a systemic overall view, the Secretary of State is holding regular “pressure” meetings and looking at the key metrics in getting those pressures down. He is also looking at how we can tackle things systemically from within, including discharge issues. We are looking at how to improve on discharges to make sure that there is enough space, thereby continuing to ensure not only that elderly patients are back in their homes as quickly as possible, but that we reduce the length of time that others have to wait for ambulances.

Covid-19 Update

Debate between Baroness Tyler of Enfield and Lord Kamall

Monday 29th November 2021 Lords Chamber

[Lord Kamall (Con)]

The noble Lord raises an important point. I will double-check the details as I do not wish to mislead him or the House. Given that this is a fast-moving situation, in which the data is very new, changing constantly and constantly being reviewed, it would be more appropriate if I double-check before I answer.

[Baroness Tyler of Enfield (LD)]

The new requirements are for all travellers arriving in the country to take a PCR test on or before day two and to self-isolate until they have received a negative test. However, on the government website today, it says that if someone has tested positive with a PCR, they should not be tested again using either a PCR or lateral flow test for 90 days, unless they have developed new symptoms. What are returning travellers who have tested positive in the last 90 days meant to do? Who is cross-checking the existing guidance against new regulations?

[Lord Kamall (Con)]

All I can do is thank the noble Baroness for her question. I will have to double-check; as she will imagine, I do not have all the answers at the moment. Throughout the day, as I was preparing for this, the advice was changing constantly, and things were being swapped in. Advisers from the Department of Health and Social Care were saying, “This is the latest advice”, but it was changing literally hourly. I will try to get the latest advice and share this with noble Lords.

NHS England: Waiting Lists

Debate between Baroness Tyler of Enfield and Lord Kamall

Tuesday 16th November 2021 Lords Chamber

[Lord Kamall (Con)]

Immigrants have always played a vital role in our country. If we cast our minds back to the post-war period, there were massive shortages in healthcare but also other public services. Indeed, my own father came over to work on the railways and buses. It shows the importance of immigration and immigrants to this country from across the world.

[Baroness Tyler of Enfield (LD)]

My Lords, does the Minister agree that the fundamental problem confronting the NHS is a lack of spare capacity and resilience? This means that the NHS is continuously running at unsustainably hot levels of bed occupancy. The UK has 2.7 hospital beds per 1,000 population compared to an EU average of 5.2, and significantly fewer doctors and nurses. What plans do the Government have to urgently increase capacity and deal with workforce shortages, which cannot all come from training new people from scratch, given the timescales involved?

[Lord Kamall (Con)]

If the noble Baroness looks at the statistics relating to the waiting lists, she will see that 75% of patients do not actually require surgical treatment: they require diagnostics. We have announced an investment in community diagnostic centres— sometimes in shopping centres or sports grounds—to make diagnostics more accessible to the public, rather than having to go to a healthcare setting. Moreover, 80% of patients requiring surgical treatments can be treated without an overnight stay in hospital, so they can do that as day patients. This is where we want to focus, along with making sure that we tackle all the waiting lists right across the board.

Covid-19

Debate between Baroness Tyler of Enfield and Lord Kamall

Monday 15th November 2021 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I thank the Minister for repeating the Statement. At this afternoon’s No. 10 press conference, Professor Chris Whitty made it very clear that doctors and scientists are increasingly concerned about the average of 37,500 cases over the last week and the high number of Covid cases in hospitals. Professor Whitty said that it would be a tough winter and added that, in addition to the nearly 9,000 Covid patients in hospital, all other areas of the NHS are under growing and intense pressure. He recommended that, in addition to getting their vaccinations, everyone should use face masks and ventilation to help reduce the number of cases.

This morning, Oliver Dowden, who was just referred to, said “It is in our hands” whether further restrictions in plan B are put in place this winter, but clearly the Government’s current communications on just encouraging using face masks and ventilation indoors and on transport are simply not cutting through. It certainly was not on my Tube journey in today, where distressingly few people were wearing a mask. Even if the Government do not want to implement the whole of their plan B, why will they not at least mandate face masks and improving ventilation on public transport and indoors when so many people across the spectrum are crying out for this to happen?

Leaving it to individual choice and personal responsibility is far too weak and inconsistent a message. It is crystal clear that the Prime Minister does not want to implement plan B, but is the reality not that he is far more likely to have to do so—or, indeed, move straight to plan C, a total lockdown—if mask-wearing is not made mandatory immediately? Does the Minister agree with me, and the point just made by the noble Baroness, Lady Thornton, that all parliamentarians and most particularly Ministers have a duty to set a clear example of mask wearing inside and on public transport?

Professor Whitty highlighted the stark figure that 98% of pregnant women admitted to hospital had not been vaccinated, and that same ratio applied to those in intensive care. What specific steps are the Government and the NHS taking to talk directly to pregnant women to encourage them to have their vaccinations?

It was worrying this afternoon when the Prime Minister said that he “hoped” that booster and third jabs could be logged on the online system “soon”. We have been asking questions about this system for weeks now. Can the Minister look into Pinnacle, one of the systems that logs people’s Covid status, to find out why practitioners are not yet able to record a third jab for the clinically extremely vulnerable, as well as a separate listing for booster jabs for everyone else over 40? As the Prime Minister said this afternoon, evidence of booster jabs will be required for travel this Christmas, but because third vaccinations and booster doses are still not appearing separately on the NHS Covid app, there is a great deal of anxiety and frustration among people who will need not only to have had the jabs but to be able to provide the evidence. Can the Minister say—I underline the point made by the noble Baroness, Lady Thornton—when all third doses and boosters will be on the online system?

Finally, although I welcome the announcement that it is safe for 16 and 17 year-olds to receive a second dose, can the Minister explain where 16 and 17 year-olds will be able to get that second dose? Too often, young people wishing to have their initial jab were put off because they had to travel to a centre some way away, often by bus, train or car, often involving parents providing the transport. Will the Minister undertake to look into ensuring that there are centres in town centres and other easily accessible places so that young people can more easily access their second dose?

[Lord Kamall (Con)]

I thank the noble Baronesses for those sets of questions; I will answer them as best I can. I will work backwards, starting with where people can get their vaccines: the same places where the rest of the population can get their vaccines. Only last week, I booked my booster and was reassured to find that, rather than having to go even to my local doctor—which I was quite happy to do—there were two or three pharmacies, or chemist shops, near me that were giving the booster. One of my sons has booked his vaccine and that will be at the same pharmacy. So, clearly, we are rolling out the vaccines to more accessible places than initially; I do know someone considered clinically vulnerable who had to go quite far before, but we are now bringing the vaccines as close to people as possible.

I will try to answer some of the other questions. We are focused on building a wall of defence across the country. More than 261,500 hospitalisations have been prevented in those aged 45 and older, up to September 2021. Estimates suggest that 127,000 deaths and 24 million infections have been prevented as a result of the Covid-19 vaccination programme. This is why we are keen to stress that vaccination remains the best defence against this virus.

We are also working hard to make sure that as many people as possible have their jab as soon as they can. While we are very encouraged by the booster uptake and the record numbers, only today I have been in meetings where we have been talking about how to reach those hard-to-reach communities. I know that we have spoken about this before in this House. I have, very kindly, been offered advice from noble Lords across the House and I have been working with some noble Lords in relation to their experience as community organisers or working with certain communities where the demographics have shown a lower uptake. We are rolling out the programme, and there will be a publicity programme rolling out as well. As we get more data, the JCVI and others are even more reassured by the safety of the vaccines and want to stress that as much as possible.

As I said, we are rolling out the booster programme. Nearly 10.6 million people have now received their third dose, and we are looking to vaccinate children as quickly as possible. We are working closely with schools, colleges et cetera to make sure that we get as close to people as possible.

I had hoped to be able to give a date for the booster appearing on the app. A number of noble Lords raised this with me both formally and informally, and I got straight on to NHSX to try to get an answer. I had hoped to be able to announce a date today, but I am still not able to do that. I am told, however, that good news will be available soon, and I hope it will be announced as quickly as possible. I think there are a few more checks to go through; those who have been in government before will understand how this works.

On the issue of NHS capacity, as of 12 November the number of beds occupied by Covid-19 patients had decreased by about 4% across England in the last week. Regionally, there was a drop of 4% in the east of England; a 2% increase in London; a 5% drop in the Midlands; an 8% drop in the north-east and Yorkshire; a 5% drop in the north-west; no real change in the south-east; and a drop of 8% in the south-west. Hospital admissions have decreased by 10% across England last in the week. There was a drop of 16% in the east of England; an increase of 1% in London; a drop of 11% in the Midlands; a drop of 15% in the north-east and Yorkshire; a drop of 11% in the north-west; a reduction of 8% in the south-east; and a drop of 10% in the south-west. Rates of admission to hospital with Covid-19 therefore appear to be decreasing. Hospital admissions in England were at 821 people per day as of 10 November. There were 6,777 patients in hospital in England as of 12 November, including 838 patients in mechanical ventilation beds.

In line with the approach that we have taken, we are constantly relying on data from the JCVI and its judgment, and this is constantly being reviewed in terms of rollout to different age groups. We are very fortunate to have secured a steady supply and delivery of Covid-19 vaccines. Many will also be aware of the other method by which the dose can be taken.

On making sure that we are focusing on elective care recovery, we have given £2 billion to help tackle the backlog that built up during the pandemic and have committed £8 billion over the next eight years. We hope that that funding will deliver the equivalent of 9 million more checks, scans and procedures to tackle the backlog, and we hope to have 30% more elective activity by 2024-25.

Turning to care homes, one of the campaigns being launched is the “made with care” campaign, which is advertising the fulfilling careers that can be had as social carers. It is very much focused on people who want to make a difference to other people’s lives. There is £550 million, including £162.5 million on the “made with care” campaign, and noble Lords will see that campaign rolling out.

Fortunately, 90% of staff in in older-adult care homes have received both doses, and 94% of such staff have had at least one dose. The data we are getting shows that, where care home owners are able to sit down with the workers who may have some doubts, there is an increase in uptake. Also, on a temporary basis until 24 December, people who have a medical reason why they are unable to have a Covid-19 vaccine can self-certify that they are exempt on medical grounds until that can be proven one way or another.

I am trying to make sure that I am answering all of your Lordships’ questions. If there are some that I have missed, let me assure noble Lords that I have not done so deliberately, and I will write to them to fill that information gap.

Social Care

Debate between Baroness Tyler of Enfield and Lord Kamall

Wednesday 27th October 2021 Lords Chamber

[Lord Kamall (Con)]

In looking at how we reform the adult social care workforce, we have consulted a wide range of stakeholders, not only on what we do from 2022 to 2025 but on what we do in the short term. Further details will be announced soon.

[Baroness Tyler of Enfield (LD)]

My Lords, £1 in every £12 spent by local authorities on social care goes towards funding mental health social care, supporting people of all ages who live with severe mental illness, and their carers. Can the Minister say what proportion of the planned levy will be used to fund mental health social care, which provides such a lifeline to all those affected?