Mental Health Bill [HL]

Lord Berkeley of Knighton Excerpts

Committee stage
Monday 24th February 2025 Lords Chamber

[Baroness Butler-Sloss (CB)]

My Lords, I come to this totally uneducated, so what I have heard this afternoon I have found very shocking. I agree with what has been said already, and I was particularly shocked by the comments from the noble Earl, Lord Howe. I would like to underline what the noble Baroness, Lady Berridge, has said about the fact that these are children. They may be 17 and a half but, under the Children Act 1989, they remain children and, across all legislation dealing with children, “best interests” comes in.

From what I have heard, it sounds as though adult wards do not understand that these are genuinely children and have to be treated separately but, much more importantly, that their best interests are not necessarily, or almost certainly not, the same as those of adults. I wonder whether it should not be permeating all establishments, private and public, that, if they have to take into an adult setting those under 18, they have to deal with them in a special way. I remain horrified by what was said and I hope that the Minister, who is a particularly sympathetic person, will pick this up and take it across the board.

[Lord Berkeley of Knighton (CB)]

My Lords, I am only marginally less shocked than the noble and learned Baroness. The reason for that is that I regularly visited a friend in an adult ward, suffering, funnily enough, from eating disorders, among other things. So I support Amendment 144 most strongly. What shocked me was that, over several years, there were two children I saw. They were witnessing not only acts of violence but sexual acts too that were quite clear—I will not go into the details, but it was completely inappropriate for a child to be witnessing this.

The final point I want to make hinges on what we have also heard: that there is only so much we can do. Of course, the reason for that, and it is another reason why these experiences are seared into my mind, is the state of funding for mental health. No one can turn that switch on immediately, but the root problem here is that this is a sector that is somehow pushed to the side. Therein lies a fundamental reason why we have to take a completely different attitude to mental health, and I am sure that the Minister feels quite strongly about that herself.

[Baroness Merron (Lab)]

My Lords, I will turn first to Amendments 142, 143 and 144, in the name of the noble Earl, Lord Howe, supported by the noble Lord, Lord Kamall, and joined by the noble Baroness, Lady Tyler, on Amendment 143 and 144. I will also address Amendment 159 in the name of the noble Baroness, Lady Berridge.

I thank the noble Earl, Lord Howe, for the way in which he introduced this subject and for the understanding and shock shared by the noble Lord, Lord Berkeley, and the noble and learned Baroness, Lady Butler-Sloss. I am sure we all share the thoughts and views that they have expressed. I also thank the noble Earl, Lord Howe, for his reference to Blooming Change. I certainly recognise the important work that it does. The way he introduced its observations and experience really highlighted the reality of what we are here to deal with.

On Amendment 142, it is crucial that people with physical disabilities have equal access to mental health services. Under the Equality Act 2010, those providing mental health services, including under the Mental Health Act, must make reasonable adjustments to ensure that people with disabilities are not at a disadvantage. Therefore, the aims of this amendment are already covered by existing legislative requirements. I heard what the noble Lord said about an example of where this was not the case. I can only add my own comment to say that this is, of course, not acceptable and not at all how legislation would expect a provider to act.

We will review the guidance on how to support individuals with a physical disability, including children, when we consult on the revised code of practice and as part of NHS England’s new service specification, which will set out requirements for children and young people’s mental health services. I hope that will be helpful to meet the points raised in Amendment 142.

I turn now to Amendments 143, 144 and 159. The policy of NHS England is clear that children and young people should be able to access the right type of service, as close to home as possible and in the least restrictive environment. We do not want to see children and young people on adult wards or placed far from home. We are working to secure the necessary investment to expand community-based support and specialist beds to prevent this from happening. I am grateful to the noble Earl, Lord Howe, for referring to the need to deal with where we are rather than where we might like to be. That is what we intend to do.

There are already provisions in the Act that seek to limit inappropriate placements for children and young people. Under Section 131A, hospital managers must ensure that the patient’s environment is suitable, having regard to their age. We believe that the careful consideration and nuance involved in determining any circumstances where it is in a child’s best interest to be treated on an adult ward or in an out-of-area placement fits better in a revised code of practice rather than legislation, which would apply fixed rules that could not be adapted to individual circumstances or service provision.

We will provide additional guidance on the process to determine, and review throughout a child’s detention and treatment, that the environment in which they are accommodated continues to be in their interests. Such matters can be addressed through the new service specification for specialised children and young people’s mental health services.

I assure the Committee that there are already clear operational processes in place to identify and monitor children and young people in inappropriate placements. It is a statutory requirement for the CQC to be notified within 48 hours if a child or young person is placed on an adult ward. The CQC reports on the number of people under 18 admitted to adult wards as part of its Monitoring the Mental Health Act reports.

The CQC project on improving regulation for children inappropriately placed will identify what CQC can do to prevent children being cared for by providers who cannot meet their needs and to reduce their risks of being exposed to poor-quality care. I assure the Committee that we will review the process for who should be notified, and in what circumstances, in the new service specification for specialised children and young people’s mental health services, and in the revised Mental Health Act code of practice.

I turn to Amendment 160, tabled by the noble Baroness, Lady Berridge, on the extension of Section 17 of the Children Act 1989 to include children detained under the Mental Health Act. Section 17 places a duty on local authorities to provide support for children who are unlikely to reach or maintain a satisfactory level of health or development, or where their health or development would be significantly impaired without the provision of services—or where the child is disabled.

East Kent Maternity Services: Independent Investigation

Lord Berkeley of Knighton Excerpts

Monday 24th October 2022 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend for her question; I know this is an area in which she has longstanding interest and expertise. She refers to embedding compassionate care and, perhaps like all of us, I am surprised to learn that, unfortunately, we may need training in this area; but I agree that it needs to be done because it is fundamental. A culture and leadership programme has been put in place, and we have set up national guardians, the idea being that everyone in every trust has the freedom to speak up. There are 800 of them as of today. I take this issue seriously and I commit—if I am here—to come back within four to six months to report to the House on the progress made, as requested.

[Lord Berkeley of Knighton (CB)]

My Lords, all too often we hear sentiments of regret and apology—“we have learnt lessons”; “it must not happen again”—and of course, in a sense, what else can you say? My noble friend’s suggestion of someone with specialist knowledge overseeing this is very helpful, but does the Minister agree that this is another area where we have to encourage people to whistle-blow? It is not a term I like much, because it suggests something which is not pleasant, but very often there are people who are alarmed and think something is wrong, but who are too frightened to speak out. If we could foster a culture where that fear is diminished and people feel able to speak out, and that they should, we might get much earlier warning.

[Lord Markham (Con)]

I agree, and if I may I would like to quote Dr Bill Kirkup in the report:

“Clinicians should not have to live in fear”


where “honest clinical errors” are made. That is exactly the point: we need to introduce a culture whereby people feel able to do that. He goes on to blame systemic failures in leadership, a point that the noble Baroness, Lady Brinton, made, and which is very pertinent here. We are talking about honest mistakes. Everyone wants to do a good job and tries do a good job; it is where they feel that they cannot bring up and honestly discuss those issues that we have a systemic problem, so I agree that it begins and ends with the leadership.

North East Ambulance Service

Lord Berkeley of Knighton Excerpts

Monday 23rd May 2022 Lords Chamber

[Lord Kamall (Con)]

I take the noble Lord’s point that you cannot look at things in isolation; we have to take a systemic view. Are these issues confined to the ambulance service or is it the wider NHS or the wider trust? These are all issues that have to be looked at. On the workforce plan, I assure the noble Lord that I have tried, but clearly there are issues. Health Education England has been mandated to come forward with workforce strategies, and there are workforce strategies at trust level as well.

[Lord Berkeley of Knighton (CB)]

My Lords, does the Minister agree that we have to be much more proactive in encouraging people to have the courage to be whistleblowers? It is the only way we are going to learn. Secondly, should we not outlaw NDAs of this sort, so that they cannot suppress information that is vital to the well-being of society? I agree with the previous speaker who said that we need to change the culture around this, not just small points.

[Lord Kamall (Con)]

Noble Lords are absolutely right to talk about the culture. Years ago, during my academic career, I looked at organisational change; one of the very difficult issues is that while you can change structures and processes, it is about how you address the culture. Quite often in organisational change, or any change, there is a cultural lag. Sometimes the lag is due to individual values and sometimes it is much more widespread than that, and there are questions about how the culture grew in the first place and how to address those roots. Sometimes it is about personnel change and sometimes it is about retraining. There are a number of issues when it comes to changing culture, which is quite often more difficult than structural change.

The Government have been clear, as has the NHS, that there are clear guidelines around the use of NDAs by the NHS, including that it should not prevent staff speaking up about concerns relating to the quality or safety of care. It will be important for us to discuss all the issues further with the trust, the CQC and others, to determine the appropriate steps to take from here, including on NDAs.

Covid-19 Update

Lord Berkeley of Knighton Excerpts

Tuesday 6th July 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I completely concur with my noble friend’s analysis. This is an opportunity for the economy to bounce back, and I am really encouraged by everything I hear from the private sector in terms of the energy, enthusiasm and resilience of the UK economy. The large number of people who will be holidaying at home this summer provides one shot in the arm for the hospitality industry, which I know it is taking advantage of.

When it comes to borders, we have to be careful. One does not like to think about it, but the existence of millions and millions of people with the disease today means that the possibility of further variants has to be on the agenda. That is why we take it one step at a time, and I pay tribute to those in Border Force and the managed quarantine scheme for the work they have done. It is ironic that the variant delta, which started in India, is now so prevalent in the UK that it is possible to think about India coming off the red list. But there are variants elsewhere that we have to be wary of.

[Lord Berkeley of Knighton (CB)]

My Lords, is the Minister aware—I think he may not be given his recent response to the right reverend Prelate—of the latest government-sponsored PERFORM-2 scientific research? It substantiates what noble Lords have been telling the Government for weeks: there is no difference in aerosol droplets between professional and amateur singers. Given this, is it not time now to finally stop an indefensible farce that restricts amateur choirs from singing, just as they observe tens of thousands of football and tennis fans chanting away? It is no good on counting on 19 July to sort it out as there may be further prohibitions in the future.

[Lord Bethell (Con)]

My Lords, I am not aware of all the details of the latest Statement. It is my understanding that there is substance there; I gather that there will be change and I look forward to reading about that.

The noble Lord gives me an opportunity to reflect widely, and I hope he does not mind if I do so. There have been lots of uncomfortable inconsistencies and moments of disproportionality where noble Lords have rightly challenged the Government as to whether they have got every dotted “i” and crossed “t” absolutely right. The singing issue is probably the most graphic and certainly the most discussed example. I will personally be hugely relieved if we can move on from the current situation.

Covid-19 Update

Lord Berkeley of Knighton Excerpts

Thursday 4th March 2021 Lords Chamber

[Lord Bethell (Con)]

My noble friend is entirely right to raise the issue of regional variation. It had been our profound hope to be able to adjust and to focus lockdown arrangements on geographical locations so that national measures were not the only tool in our toolkit. The evidence from last year suggests that the amount of travel that individuals do makes regional and local lockdowns only partially effective. This has put a massive question mark over the way in which we can use regional and local lockdowns. There is more work to be done to understand exactly how that works but he is right to raise it as a considerable issue.

[Lord Berkeley of Knighton (CB) [V]]

My Lords, it is a great pleasure to congratulate the Minister on behalf of the Government on what has been achieved in lockdown. It is absolutely fantastic. I want to ask two questions. First, bearing in mind that some 20 million people have now been vaccinated, do the Government have any assessment of the number of people who still contract the disease after having had the vaccination? Secondly, do the Government have any idea about the relative impact of side-effects of the different vaccines?

[Lord Bethell (Con)]

My Lords, I have nothing but good news on both those important issues. The number of people who have mild or profound sickness, need hospitalisation or die after having the vaccine is extremely small indeed. There is some differential when we come to the variants of concern. Certainly, mild disease has been observed with the South African variant by sources in South Africa and we are working to understand that. However, severe hospitalisation and death are massively reduced by all the vaccines. The side-effects from all the vaccines on all age groups and on people with almost all comorbidities are extremely small. The yellow list information published by the MHRA is extremely reassuring and so far it has been nothing but good news about the vaccines.

Health Protection (Coronavirus, Restrictions) (Self-Isolation and Linked Households) (England) Regulations 2020

Lord Berkeley of Knighton Excerpts

Thursday 7th January 2021 Lords Chamber

[Lord Berkeley of Knighton (CB) [V]]

My Lords, I will ask the Minister two slightly uncomfortable questions. First, it is always very important, when one tries to set an example, that we look at ourselves. Does the Minister feel that, in terms of attendance and mask wearing, we in the Chamber and at Westminster are setting the right example? Is there anything we could do better?

My second point is this. I have been reading a book, Breathtaking: Inside the NHS in a Time of Pandemic, by Dr Rachel Clarke. Anybody who read this book would think twice about breaking the rules. I want to go further than the Government in some aspects. For example, the fact that going to a party or organising a party might mean you get a £60 or £500 fine should be seen in the light of the fact that it could cause a porter, a cleaner, a nurse or a doctor to visit not merely ICU but the mortuary. If people thought about this more carefully and the penalties were much more draconian, they would think twice about their behaviour. I am shocked that people might get a fine of £60—a parking meter fine—for going to a party, spreading this pandemic and putting so many lives at risk.

Personal Protective Equipment: Procurement

Lord Berkeley of Knighton Excerpts

Thursday 19th November 2020 Lords Chamber

[Lord Bethell (Con)]

I ask my noble friend to look beyond newspapers for his analysis of the report. I take the five recommendations very seriously. They are encouraging and ally absolutely with the Government’s values. We will look at how to implement them in due course.

[Lord Berkeley of Knighton (CB) [V]]

My Lords, I listened yesterday to the Minister’s response to a similar Question. I accept that Governments were under an incredible strain, but many were better positioned and prepared than we were. Does the Minister have any regrets to which he will own up about the way in which money was handed out to procure PPE?

[Lord Bethell (Con)]

I have to be careful about what I say because legal proceedings are in place. The noble Lord is right; I do not pretend for a moment that everything was perfect. I have spoken quite candidly—possibly more candidly than I should have—about the challenges that we faced. Not everything was perfect or ran smoothly, and no well-honed machine sprang into life. However, I am proud that we reacted with energy, skill and elan. We made the most of a very difficult and unprecedented situation. I cannot hide my gratitude to those who stood up to help. Offers of help came from all sorts of places. We should be cheering them and not in any way attacking them.

Covid-19: Conflicts of Interest

Lord Berkeley of Knighton Excerpts

Wednesday 18th November 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, my noble friend makes a very good point. I cannot tell him how long it would typically take but I can tell him that if everything went as smoothly as possible, 25 days is the absolute minimum that a procurement process could take. That is why, on 18 March, new guidelines for procurement were put in place. The PPE team converted those into a very diligent eight-step process, the effectiveness of which the NAO has paid tribute to. We have put in place exactly the kind of reasonable processes necessary to respond to a pandemic like this, resulting in the purchase of billions of items of PPE to protect those on the front line of our healthcare.

[Lord Berkeley of Knighton (CB) [V]]

My Lords, I do not discount the many problems the Minister has talked about, but the displeasure—disgust, even—of the public often arises as a result of the National Audit Office uncovering information reactively, for example. What we need is a more proactive lookout for these problems, either in the Cabinet or the Cabinet Office. If the Minister says it is there, I would suggest that the National Audit Office is saying that it does not work very well.

[Lord Bethell (Con)]

My Lords, I am not sure that that is what the National Audit Office has said. It has, very reasonably, alighted on the importance of transparency and the declaration of interests, values that any reasonable Minister or public servant would subscribe to. The Cabinet Office itself has played a very energetic role during the entire pandemic, providing the systems, support and people, including contract staff, to make sure those values are upheld.

Health Protection (Coronavirus) (Restrictions) (England) (No. 4) Regulations 2020

Lord Berkeley of Knighton Excerpts

Wednesday 4th November 2020 Lords Chamber

[Lord Berkeley of Knighton (CB) [V]]

My Lords, I have considerable sympathy with those like the noble Lords, Lord Howard of Rising and Lord Forsyth, and my noble friend Lord St John of Bletso, who feel that the cost of lockdown is simply too great or even that the road to herd immunity would be a preferable route. As someone with a financial toe in the hospitality arena—as declared in the register of interests—I also have great sympathy with those who are struggling; indeed, I worry too about the artists and freelance musicians who will once again be hit and may fall between the Government’s safety nets, as mentioned by my noble friend Lord Clancarty.

But—and it is a big “but”—despite this, and despite the utter incompetence over testing, with all the Prime Minister’s Trump-like boasting about us being world-beaters, I feel that we simply cannot risk people’s lives. The NHS is adamant—adamant—that without a circuit breaker, this is what we would be doing. In fact, if the figures that we are being asked to swallow are correct, we should have locked down sooner and also used the natural break of the school half-term to widen that circuit breaker still further.

The noble Lord, Lord Thomas of Gresford, made some well-argued points about Wales. In my area of mid-Wales, we had virtually no cases at all until the last two weeks, when, suddenly, two groups of people contracted Covid. How? Both groups went to either a bar or a pub. Alcohol leads to loss of inhibition and lack of safe distancing. Since people are not prepared to play by the rules, the Government need to impose them so that we do not see hospitals having to close their doors. I am not prepared to take responsibility for having on our conscience the deaths of patients who cannot be looked after, not to mention the terrible stress on doctors, nurses and NHS staff.

I believe what the Minister said in his opening comments. Therefore, despite my love of tennis, I must support the Government in these regulations, though with some reservations.

Covid-19 Update

Lord Berkeley of Knighton Excerpts

Monday 16th March 2020 Lords Chamber

[Lord Bethell]

The Government are under no illusions about the size of the challenge. The package announced in the Budget was an initial commitment. Whatever funds are needed will be made available, in particular to support the NHS and our social care but also to support hard-working businesses and those that provide employment and sustenance to the country.

[Lord Berkeley of Knighton]

My Lords, could I tempt the Minister to say a little bit about the antibodies test? Obviously, the test being used at the moment to tell you if you have coronavirus is a swab test. But the one that could make a huge difference to NHS staff would be an antibody test, particularly if it gave one immunity. This could completely transform the workforce and people’s ability to get to work if they had been exposed in the past. Could he say a little more about that?

[Lord Bethell]

The noble Lord has hit upon an essential conundrum of the testing framework. I am not the expert who can give chapter and verse, but my layman’s understanding is that the antibodies test on which he rightly focuses is some way away. The biggest difficulty for testing is knowing who has had the virus but never shown the symptoms. Unfortunately, one of the difficult challenges for our response is not yet having that test; it holds us back, but we are working on it very hard indeed.