Mental Health Bill [HL]

Lord Cryer Excerpts

2nd reading
Monday 25th November 2024 Lords Chamber

[Lord Adebowale (CB)]

My Lords, this has been a fascinating debate so far. It is an honour to contribute and to listen to so many learned Peers around the House. In fact, earlier on I detected an almost kumbaya moment around the agreement on some of the aspects of the Bill.

I declare my interest as chair of the NHS Confederation, which is a membership organisation representing health and care leaders in England, Wales and Northern Ireland. We have the privilege of having 100% of all mental health trust leaders in membership.

This debate is overdue, just as updating the Mental Health Act is long overdue. I could not help thinking, during the contributions of the noble Lords, Lord Meston and Lord Scriven, that if we were to go back to 1959, this House would be of archaeological interest before we got anywhere near where we have got to today—so we shall start where we are and continue to make the Bill the best it can be.

I should also point out that a member of my family is on the autistic spectrum, so I get it, just as people who have that experience also get it.

Organisations such as the NHS Confederation have warned that the success of reforms will be dependent on the wider infrastructure to support them. My first question to the Minister is: can she confirm that as well as the important measures in the Bill, we will see further details in next spring’s spending review and in the 10-year NHS plan about how patients and staff working in mental health will be supported in years to come?

The Bill is welcome, not least because it is intended to stop people with learning disabilities and autistic people from being detained long-term, unless they also have a serious mental health condition, but only when there is sufficient and appropriate community care in place to support them. It is clear, therefore, that a plan on how this capacity will be built up is vital; otherwise, people will continue to be detained inappropriately. Can the Minister provide more details on what the Government will do to ensure that we see that capacity is built up, so that people with learning disabilities and autistic people are able to benefit from the support that community care can provide?

Concerns have also been highlighted to me by many of our members and other organisations that the changes for people with learning disabilities and autistic people may unintentionally risk these groups falling into the criminal justice system due to a lack of community provision, as mentioned by the noble Baroness, Lady Watkins. This is similar to the changes in New Zealand she referred to, which led to people with learning disabilities and autistic people sometimes being sent to prison and left neglected in the community or admitted to forensic facilities as secure patients, as they were unable to be detained under its equivalent of the Mental Health Act.

I welcome the safeguards that the changes relating to people with learning disabilities and autistic people will be enacted only once sufficient provision is in place. Can the Minister provide more details on what the Government will do to ensure that capacity is built up so that people with learning disabilities and autistic people are not inappropriately—and indeed unintentionally—detained for many years, often far away from home and for very long periods?

The Government are committed to enacting the changes to detention regarding people with learning disabilities and autistic people only once sufficient community provision is in place to reduce the risk of these people falling into the criminal justice system. Again, can the Minister outline how the decision to enact this part of the legislation will be made?

The reforms that we are debating introduce duties on commissioners to ensure an adequate supply of community services to prevent inappropriate detentions in hospital, but without a funded plan to build up this provision, there is a risk that the proposed changes to the legislation will never be enacted, and people will continue to be inappropriately detained. Can the Minister say what measures the Government will put in place to help commissioners get it right at local level?

In addition, as the noble Lord, Lord Bradley, mentioned, referring to the 28 days, some people are very concerned that it is not long enough to complete a thorough assessment to identify whether patients with a learning disability or autistic people have a co-occurring mental health disorder, due to the complexity of what patients often present. Does the Minister acknowledge these concerns, and will she remain open to discussions with the sector throughout the passage of the Bill so that the views of those who work day to day with vulnerable people, as well as the views of people with learning disabilities and autistic people and their families, can be fed directly into the legislative process?

It is nice to note that many have referred to the stark racial inequalities in the use of CTOs, and wider concerns around their use. However, mental health providers and many professionals agree that they can be beneficial to patients as they can be the least restrictive option, and we welcome the Government’s commitment to reviewing CTOs. Can the Minister share details about the scope and timescale of this review?

The NHS Confederation has raised concerns about high vacancy rates across the sector, which are bound to impact on staff capacity. Again, can the Minister give assurances that this will be addressed as soon as possible, if not as part of this legislation then through the upcoming 10-year plan or the review of the NHS workforce plan? This was mentioned by the right reverend Prelate the Bishop of London, and indeed the noble Baroness, Lady Buscombe, whose points on data I also agree with.

The NHS Confederation has pointed out that more opportunities for patients to challenge their detention are likely to increase the number of tribunal hearings. This would require an additional 33% expansion of the in-patient responsible clinician workforce. Given that national consultant psychiatrist vacancy rates are currently around 10% to 15%, this will be very challenging. With the Government set to publish an updated long-term workforce plan for the NHS next year, as mentioned earlier, can the Minister give an assurance there will be measures in this plan to specifically tackle workforce shortages in mental health?

In referring back to the issue of racial inequality, the patient and carer race equality framework is the key vehicle in reducing the racial disparities that exist in the Mental Health Act and in wider services—which mean, for example, as we mentioned, that black people are far more likely to be detained under the Act or to be placed on a community treatment order than white people. The so-called PCREF is not part of legislation, but all mental health providers are expected to implement it. Concerns exist that the lack of understanding of the framework, as well as the lack of resources available, are hampering its implementation. Again, will the Minister consider using legislation to address these concerns?

Racial disparities are a significant issue, and the NHS Confederation has described the disparities in rates of detention of people from different racial backgrounds as unacceptable—I agree. For example, black people are more than three times more likely to be detained under the Mental Health Act. There is evidence that advance choice documents reduce racial disparities in the level of detentions. This led to many in the sector calling for them to be made statutory. Indeed, this was recommended by both the Mental Health Act review and the pre-legislative scrutiny committee which looked at the draft Bill. Can the Minister set out why advance choice documents will not be made statutory? Is she confident that measures in the Bill concerning such documents will help reduce those racial disparities in detention rates? There are very few evidential interventions that actually reduce racial disparities, so let us use the one that we know works.

The NHS Confederation has highlighted concerns that the new criteria for detention set out in the Bill—namely, that serious harm may be caused—need to be defined. If they are not, we risk inconsistency in how the definition is interpreted. Will the Minister come forward with a definition of what constitutes serious harm so that there can be no doubt about what this means in practice?

Funding for new mental health crisis centres announced in the Autumn Budget was welcome, but we need to see more funding provided for the NHS and mental health in the coming years. As the confederation has pointed out, successful implementation of the legislation we are debating will depend on ensuring that the workforce and resources are in place. That includes capital funding to improve the safety and therapeutic environments of in-patient wards. I have seen some shocking places, as no doubt many noble Lords have. Can the Minister say whether, alongside these much-needed reforms, we will see further funding for mental health in next spring’s spending review? I urge her to speed dial the Treasury.

The Government estimate the overall cost of the reforms to be around £5.3 billion for housing, health and social care costs and £313 million for costs to the justice system in England and Wales. The upcoming 10-year plan and next spring’s spending review are key opportunities for the Government to acknowledge what is needed to enact these reforms. The money for the NHS in the Budget was very welcome. I am a big fan of £22 billion for the NHS, but will the Minister give an assurance that further funding will be made available so that these reforms have the best chance of being effective?

The Government’s commitment to shift more care into the community is welcome because it supports better patient outcomes and is a more efficient use of funding. However, the NHS Confederation and I are among those who have pointed out that we need to make sure that the right provision is in place for that community care. Can the Minister provide assurance today that the Government acknowledge this, and can she set out the Government’s plans to ensure that we have this provision?

As the NHS Confederation pointed out recently, on behalf of our members, people with mental health needs and those with learning disabilities—

[Lord Cryer (Lab)]

Let me just point out that the limit of nine minutes is voluntary, but a lot of people want to speak.

[Lord Adebowale (CB)]

I know. I have two things to say and then I will finish, honestly. People with mental health needs, those with learning disabilities and autistic people are waiting too long for appropriate care and support. The mental health estate has also experienced years of underinvestment. Can the Minister give an assurance that alongside this Bill, the Government will use every opportunity they have with the 10-year plan and the upcoming spending review to ensure that we see further investment in care and support for those who need it and into the mental health estate?

Oral Answers to Questions

Lord Cryer Excerpts

Tuesday 11th July 2023 Commons Chamber

[Neil O'Brien]

My hon. Friend is completely correct. That is why at the end of last month we laid a statutory instrument before the House to fix the system, so that pharmacists can spend more time using their skills to provide high-end clinical services and less time snipping blister packs.

[John Cryer (Leyton and Wanstead) (Lab)]

Given the national shortage of GPs, does the Minister recognise that there is a potential danger in asking pharmacists to take on the duties of GPs—duties that they are not necessarily qualified to undertake—especially given the already large workload undertaken by pharmacists?

[Neil O'Brien]

We absolutely recognise the need for patient safety, which is why there will be clear patient group directions and clear pathways about what pharmacists do. They are not taking on the role of GPs, but are providing additional services that will make things more convenient for all of our constituents.

Oral Answers to Questions

Lord Cryer Excerpts

Tuesday 6th June 2023 Commons Chamber

[Will Quince]

As my hon. Friend knows, the provision of services, including accident and emergency, are a matter for local NHS commissioners and providers. I know that he regularly meets local NHS leaders about this matter and will continue to do so. I am very happy to meet him and, of course, visit. Funding for Coventry and Warwickshire Integrated Care Board has increased to over £1.6 billion this year. My hon. Friend is a huge champion for his constituents; I would be happy to meet and visit.

[John Cryer (Leyton and Wanstead) (Lab)]

The population of my constituency is due to grow rapidly over the next 10 years and beyond. On that basis, can the Minister give a completion date for the new Whipps Cross Hospital, which was announced last week?

[Will Quince]

By 2030, Mr Speaker.

Recovering Access to Primary Care

Lord Cryer Excerpts

Tuesday 9th May 2023 Commons Chamber

[Steve Barclay]

I am happy to recognise the scope for Mrs Bristow and many others to make more use of the NHS app. That app is all about empowering the patient and enabling them to get the right care, in the right place, at the right time, whether from a pharmacist, one of the additional primary care roles we are creating or a GP where applicable. The NHS app can free primary care practices from many of the tasks that are currently placed on them, such as people phoning for their records or repeat prescriptions. It is a key part of streamlining such tasks.

[John Cryer (Leyton and Wanstead) (Lab)]

In my constituency, we have lost GPs and surgeries. There are increasing numbers of people on fewer and fewer lists. Community pharmacies are under pressure and some have closed, so people then go to the local hospital, Whipps Cross University Hospital, which is struggling, with 100% bed occupancy rates. The Secretary of State has been ducking making an announcement about funding for the new Whipps since he took on the job, but that hospital is struggling every day. My question is twofold: when will the Secretary of State announce the workforce plan for primary care, and when will he finally get around to making an announcement for Whipps Cross University Hospital?

[Steve Barclay]

Far from ducking Whipps Cross, I have actually been and visited in person, so I am very familiar with the issue and I recognise the importance of the new hospital programme. I hope to make an announcement about that programme and about the workforce plan shortly, just as I am doing today about the primary care recovery plan.

In today’s plan, the hon. Gentleman may want see at the proposals to look at the contribution to pressures on primary care from new housing developments, and at what changes might be made to ensure that where such developments take place, funding from them goes not only to new schools, as it frequently does, but into primary care, and particularly GPs.

Oral Answers to Questions

Lord Cryer Excerpts

Tuesday 18th January 2022 Commons Chamber

[John Cryer (Leyton and Wanstead) (Lab)]

On the issue of capacity, the argument has always been floating around that bed numbers can be cut on the basis of medical and technological advances. That was always deeply suspect, but in the context of covid-19 and its aftermath, can the Minister assure the House that there will be no cuts in bed numbers in any future hospital reconfiguration?

[Edward Argar]

Decisions on hospital reconfigurations and changes to local hospital systems are a matter for the local NHS, following full consultation and consideration of the needs of local communities. The hon. Gentleman is right to highlight the importance of bed capacity in the NHS. The NHS as a whole will continue to look at what bed capacity is needed to meet future need.

Covid-19 Update

Lord Cryer Excerpts

Monday 21st September 2020 Commons Chamber

[Matt Hancock]

Yes. We are moving to a system where the advice is to call 111 First and then go to A&E, or call 999 if it is an emergency and you need an ambulance. That system will not only help people to be triaged for the right treatment, which may be to see a GP, go to an urgent treatment centre or go to A&E. It will also help the emergency department to know that people are coming. The combination of the two is critical. We are rolling this out over the next couple of months, and we aim to have it in place across the country by 1 December.

[John Cryer (Leyton and Wanstead) (Lab)]

Despite what the Secretary of State has said today, we are still hearing myriad stories of people—our constituents—being unable to get tested. The worst story I have heard is a constituent who was told to travel 600 miles to Aberdeen to get a test. Why is that the case, when we are constantly told by Ministers that there is no problem?

[Matt Hancock]

Nobody has addressed the problems and challenges in the testing system more than me. We need to resolve those problems, as we have in very large part resolved the problem of people being sent long distances. I would love to know the example that the hon. Gentleman cites, because I am told that that problem in the system was fixed last week, and if there is a more recent example, I want to know about it.

Covid-19

Lord Cryer Excerpts

Tuesday 1st September 2020 Commons Chamber

[Matt Hancock]

This is a very important question. Essentially, part of the research into the vaccine is research into its efficacy, which is about research into the immune response that it provokes—the antibody response and the T cell response, both of which have an impact. We are doing a huge amount of work on that and I am very happy to write to my hon. Friend with more details.

[John Cryer (Leyton and Wanstead) (Lab)]

Could the Secretary of State now answer a question that he has been asked repeatedly this afternoon about the creation of the National Institute for Health Protection? What persuaded him, in the middle of August, that it was a great idea to reorganise the structure of public health in the middle of the worst pandemic for 100 years, which is a bit analogous to reorganising the fire brigade in the middle of a blaze?

[Matt Hancock]

It is important to bring together the leadership on test and trace, the Joint Biosecurity Centre and the leadership from Public Health England into one place to make sure that our response is as effective as it possibly can be and that we are constantly searching to have the best possible response to the virus.

Covid-19 Response

Lord Cryer Excerpts

Tuesday 2nd June 2020 Commons Chamber

[Matt Hancock]

I can absolutely confirm that. I know my hon. Friend understands this, not least because I think that both her parents are doctors who are absolutely in the heat of this. In terms of the data publication, when I asked PHE to undertake this piece of work, I asked it to produce it by the end of May, which it did. It delivered it to me on Sunday, and we have published it and brought it to the House at the earliest opportunity.

[John Cryer (Leyton and Wanstead) (Lab)]

Further to the previous question, is the Secretary of State saying that the publication of the report by Public Health England into the wildly disproportionate level of deaths among ethnic minority communities was delayed purely because further work was needed on elements of it? In that case, at what point will it be published?

[Matt Hancock]

No, I am not saying that. I asked Public Health England to produce this work because I was very worried by the evidence of the increased morbidity and mortality among black and minority ethnic communities. I gave a deadline of the end of May. The work was delivered to me on Sunday, at the end of May. I considered it yesterday and brought it to the House at the first chance.

Covid-19

Lord Cryer Excerpts

Monday 16th March 2020 Commons Chamber

[Mr Speaker]

Order. I will let this run for about one hour, so if we can speed up questions—[Interruption.] It might helpful if we try to help each other and not hold each other up.

[John Cryer (Leyton and Wanstead) (Lab)]

Many of us have thousands of constituents who are either on zero-hours contracts or are self-employed. I have raised this question before, but unless the Government can offer those people some sort of minimum income guarantee, they will quickly be facing repossession and homelessness.

[Matt Hancock]

Of course I understand that, and it is part of the discussions I have been having with the Welfare Secretary and the Chancellor of the Exchequer.

Coronavirus

Lord Cryer Excerpts

Monday 9th March 2020 Commons Chamber

[Matt Hancock]

I agree with my right hon. Friend wholeheartedly on the first point. On the second, it is absolutely true that the MOD is working alongside the Department for International Development, and of course the Foreign Office, to support Brits overseas.

[John Cryer (Leyton and Wanstead) (Lab)]

Returning to the issue of statutory sick pay, can the Secretary of State confirm that all the relevant Departments are in agreement that SSP should be paid to self-employed people who are told to self-isolate?

[Matt Hancock]

We are all in agreement that nobody, including those who are self-employed, should be penalised for doing the right thing. How we get that support to them is a different question, because SSP is paid by the employer and the self-employed do not have an employer. We will bring forward a solution to that particular policy conundrum.