Mental Health Bill [HL]

Earl of Effingham Excerpts

Tuesday 14th January 2025 Lords Chamber

[Baroness Berridge (Con)]

My Lords, I rise to support the noble and learned Baroness, Lady Butler-Sloss, on Amendment 9. I know that there are other amendments in relation to the inclusion of parents and guardians. I raise just two small points in relation to this.

When one looks at where this amendment is inserted in the list, the last of the persons currently listed who would receive the report is

“the local authority in whose area the patient is ordinarily resident”.

That potentially will not always be the local authority where there is a care order. Therefore, in those circumstances, the local authority is caught with an

“other person who has parental responsibility”.

However, that is not how this is drafted in other parts of the Bill, where an

“other person who has parental responsibilities”

means guardians et cetera. For consistency of drafting, we need to look at that.

I know that the Minister has been very generous in the time that we have had with her and her officials, but we need a consistent phraseology within the Bill because with this amendment, if there was a special guardian the report would also go to the person with what is informally known as residual parental responsibility. Normally they are informed only, for instance, of the change of name of the child or if the child is going to leave the jurisdiction. We need to look at everybody with parental responsibility and have some consistent phraseology within the Bill when we are meaning the local authority when there is a care order and parental responsibility, to include all the different circumstances in which a child may have their status changed from the ordinary situation of living at home with parents when a court order is in place.

[The Earl of Effingham (Con)]

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

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

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

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

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

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

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

[Baroness Merron (Lab)]

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

Mental Health Bill [HL]

Earl of Effingham Excerpts

Tuesday 14th January 2025 Lords Chamber

I commend these amendments to the Committee and to the Government.

[The Earl of Effingham (Con)]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Support for Infants and Parents etc (Information) Bill [HL]

Earl of Effingham Excerpts

3rd reading
Friday 15th November 2024 Lords Chamber

[Baroness Berridge (Con)]

My Lords, on behalf of my noble friend Lord Farmer, I pass on thanks to all noble Lords who contributed to the Bill and for the assistance of the House for making the passage of the Bill so efficient. I note that the Bill is based on the early years review from the Department for Health and Social Care, which indicates that, at such a stressful time, many parents could benefit from some form of legislation to ensure that they are aware of the help available to them from charitable and publicly funded sources. I beg to move.

[The Earl of Effingham (Con)]

My Lords, I thank all noble Lords who gave of their time and effort to make a valuable contribution to the Bill. In particular, I pay tribute to my noble friend Lord Farmer, whose efforts on the Bill, as well as on hospices, special needs schools, prison reform and many other areas, will pay dividends for future generations.

By providing parents with accessible and reliable updates on infant care, the Bill empowers families to make informed decisions, fostering stronger family units. This aligns with our principles of personal responsibility and informed choice, helping parents independently to support their child’s development. It equips parents with early-stage guidance to help address any issues at the onset, potentially reducing future reliance on public services, which will enhance efficient government spending, with early support minimising the need for costly interventions later in life.

By offering parents resources on key topics such as nutrition, health and time-tested milestones, the Bill promotes stable and forward-looking early childhood experiences. We value family stability as a cornerstone of society, and many on our Benches view this as a proactive step towards creating responsible, well-adjusted citizens.

Finally, by providing parents with essential information, the Bill aims to reduce unnecessary visits to healthcare outlets, enabling resources to be allocated to those with more urgent and complex needs. This aligns with His Majesty’s Official Opposition’s aims to relieve pressure on the NHS and optimise efforts on the long-term sustainability and success of public services.

Hospices: Funding

Earl of Effingham Excerpts

Thursday 24th October 2024 Lords Chamber

[The Earl of Effingham (Con)]

My Lords, I thank my noble friend Lord Farmer for balloting this QSD.

As we have heard, the modern hospice movement was pioneered by Dame Cicely Saunders at St Christopher’s Hospice, who told her patients:

“You matter because you are you. You matter to the last moment of your life and we will do all we can to help you die peacefully, but also to live until you die”.


Every year, hospices in the UK assist nearly a quarter of a million people who live with a progressive or terminal illness and then support them more closely as their lives draw to a close. We must support these hospices.

Let me share some concerning statistics with your Lordships. More than two in five deaths occur in hospital, with 41% of that group dying alone. While it is impossible to quantify the monetary value of giving people the opportunity to die with dignity, hospices can play an incredibly important role in both providing excellent end-of-life care and, at the same time, freeing up expensive hospital beds in a material saving for the NHS.

The Minister for Care repeated just this month that the Government are determined to shift more healthcare out of hospitals and into the community, including to hospices. However, currently the amount spent on children’s hospice care, for example, varies widely—from £28 per child in South Yorkshire last year to £511 per child in Norfolk and Waveney. Can the Minister explain how these disparities are occurring and how she will address them?

Last year we committed to extending the £25 million children’s hospice grant. However, in a response to a Written Question on 31 July, the Government stated that they

“are currently considering the future of this important funding stream beyond 2024/25”.

Can the Minister please give us a cast-iron assurance that this vital funding stream will be carried forward?

Currently, around a third of hospice income comes from the state and the rest is made up from charitable donations and fundraising. Do the Government intend to move to a model in which the state delivers the majority of funding for hospices? If so, will the Government seek greater control of hospice provision across the country? With increased government funding, Ministers may seek corresponding increases in control over services, so can the Minister confirm that the Government will protect the independence of our hospices, which they value so greatly?

Investing in co-ordinated community palliative care services such as hospices, to reduce unnecessary hospital admissions and provide superlative end-of-life care, should be a top priority for this Government.

Ultra-processed Food

Earl of Effingham Excerpts

Thursday 26th October 2023 Lords Chamber

[Lord Markham (Con)]

To take the second question first, the industry has worked with a lot of comments on reformulation across the board—for younger children and older ones. Noble Lords will remember me saying that foods such as Mars, Galaxy, Bounty and Snickers bars have all been reformulated, as have Mr Kipling’s “exceedingly good” cakes. Clearly, we need to look across the board at it all. I know that the industry is working in the area of young people. I am happy to follow that up in writing with the precise details.

[The Earl of Effingham (Con)]

My Lords, in yesterday’s QSD on ultra-processed foods, the Minister spoke of how he had recently made a sound choice due to calorie labelling. What will the Government do to help and encourage SMEs with fewer than 250 employees to show calorie labelling on food and drinks that are not pre-packed?

[Lord Markham (Con)]

My noble friend makes a good point. I gave an example of where it had affected my own behaviour. I am sure we all have examples of when we have looked at the menu and thought, “Oh, do I really want that choice? Is it worth the extra calories?”. We want to get it proportionate, so while we want to encourage as many companies as possible to take it up, we appreciate that for small companies it is quite a bit harder. We are working with them to introduce it voluntarily if they can.

Children’s Health: Ultra-processed Foods

Earl of Effingham Excerpts

Wednesday 25th October 2023 Lords Chamber

[The Earl of Effingham (Con)]

My Lords, I thank the noble Baroness, Lady Jenkin of Kennington, for raising this key debate. I am sure that many noble Lords are familiar with the phrase “gut instinct”. The gut is our second brain. It uses the same chemicals and cells as our main brain. It helps us to digest, but also alerts us when something does not feel right. What we put into it is critical.

Noble Lords will also be familiar with the phrase “you are what you eat”. Eating nutritionally balanced and healthy food encourages good bacteria, which in turn affects the production of good chemicals. When production is optimal, our brain receives messages clearly and distinctly, and we experience a positive mental state. Food changes our mind and our mental health. We should actually say that food is medicine. There is a direct correlation between healthy diet and cognitive learning.

It is crystal clear that it is of the utmost importance for our children to have a healthy, balanced diet. It is therefore a concerning statistic that ultra-processed food accounts for almost two-thirds of what toddlers in the UK eat, and it becomes progressively worse the older they get.

While it is acknowledged that not all ultra-processed foods are harmful, there is agreement that they are typically high in saturated fat, salt and sugar. That is the type of food that can contribute to long-term illness, by changing the micro-composition in the gut, which can then lead to cancer, diabetes and cardiovascular disease. Research out early this week suggests that high-fructose corn syrup actually causes biological changes to the body that make it easier to put on weight and harder to lose it. Another worrying statistic shows that, in the past 47 years, average consumption by UK households of ready meals has increased by 549%, while consumption of certain fresh fruit and vegetables has decreased.

That goes some way to explaining the obesity levels in our children. Some 10% of four to five year-olds were obese in 2021; that increased to 23% of 10 to 11 year-olds in the same timeframe. We owe it to our children to give them the best start in life—but having a fit and healthy young population is essential to reducing pressure on the NHS. Obesity currently costs us £6 billion per year, set to rise to £10 billion by 2050. By trying to tackle the issue of our children and ultra-processed food consumption, we will in part tackle childhood obesity and further issues in later life.

Another concern is absenteeism from school due to illness. Almost one in 10 secondary school pupils missed school in the last week of September after sickness absence doubled in just two weeks. Those lost days over the course of a child’s education can have a material impact on their learning and development. If we are able to reduce in some way illness absence through healthier eating, that must be a positive.

If we are to protect the health of our children and prevent diet-related disease and complications, we should be reducing consumption of ultra-processed foods, and combining that with eating more lean meat, fruit, pulses and vegetables. What are the Government doing to educate children in healthy eating and cooking? Education must be key. If people really understood the harm that they are doing to themselves by eating foods that are high in saturated fat, sugar and salt, they might be able to adapt their buying patterns.