Mental Health Patients: Discharge

Lord Bradley Excerpts

Tuesday 5th March 2024 Lords Chamber

[Lord Markham (Con)]

The noble Lord is correct. I agree that it is important that the funds are spent on discharging mental health patients at a community level. I do not have the percentage figures to hand, but I will make sure that I provide them to him.

[Lord Bradley (Lab)]

My Lords, I declare my interests as in the register. Does the Minister think that there are lessons to be learned from the excellent RECONNECT programme by NHS England? It is being rolled out across the country and tries to ensure that vulnerable people, such as those with mental health conditions, are reconnected to local services, and that their release from custodial settings can be successfully undertaken.

[Lord Markham (Con)]

Yes, in a word. We must try to make sure that each integrated care board has a mental health lead in place and that the services are rolled out. Much of the strength of the ICBs is that they can look after the needs of their area in ways that they know best. At the same time, where there is good practice, we must make sure that it is rolled out as well.

Allied Health Professionals: Prescribing Responsibilities

Lord Bradley Excerpts

Tuesday 6th February 2024 Lords Chamber

Asked by

[Lord Bradley]

To ask His Majesty’s Government what progress they have made on extending prescribing responsibilities to more allied health professionals.

[Lord Bradley (Lab)]

I beg leave to ask the Question in my name on the Order Paper and declare my interests as listed in the register.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

In September 2023, we completed two consultations to amend the Human Medicines Regulations to enable dental therapists, dental hygienists and pharmacy technicians to supply and administer medicines without the need for a prescription. We aim to publish the consultation response in the next few weeks. In December 2023, the Misuse of Drugs Regulations 2001 were amended to enable independent prescriber paramedics and therapeutic radiographers to prescribe certain controlled drugs.

[Lord Bradley (Lab)]

I thank the Minister for that response, but primary and community health services, particularly general practice, are under great work- force pressure and waiting times for patients are unacceptably long. Although the plan to extend pharmacy prescribing is welcome, an important next step must be to extend appropriate independent prescribing and referral rights to a wide range of allied health professionals, including speech and language therapists, occupational therapists, diagnostic radiographers and many more similar professions.

As the Minister will know, the Lords Integration of Primary and Community Care Committee’s recent report supported this, and there was previously an unpublished NHS scoping report. Will the Minister now publish that report and act on the Lords committee’s recommendations to quickly implement the benefits for speedy and integrated patient care?

Mental Health Act 1983

Lord Bradley Excerpts

Tuesday 21st November 2023 Lords Chamber

Asked by

[Lord Bradley]

To ask His Majesty’s Government what plans they have to reform the Mental Health Act 1983.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

We are committed to improving the care and treatment of people detained under the Mental Health Act, including taking forward non-legislative commitments such as culturally appropriate advocacy, as well as continuing to expand and transform NHS mental health services. I am grateful to the noble Lord and his colleagues on the Joint Committee for their work on the Bill to date, and I assure him that it remains our intention to bring forward a Bill when parliamentary time allows.

[Lord Bradley (Lab)]

My Lords, for over six years, the Government have promised to reform the 1983 Act, from manifesto commitments to the Wessely report, draft Bills and consultations, and now the Joint Committee which reported to this House in January of this year— 11 months ago. Then, to the astonishment and no little anger of thousands of people with mental ill health, autism and learning disabilities, who have been supported by their tremendous advocates, there has been deafening silence from the Government. Now the proposed Bill has been completely dropped from the legislative programme. There is a real feeling of frustration across the country about this situation. Will the Minister now give a real explanation so that we can try and restore the breakdown of trust that has come about from this situation?

[Lord Markham (Con)]

I understand the frustration and disappointment about the fact that the Bill has not been brought forward. I am keen to focus on what we can do in the meantime. Of course the Bill is trying to decrease the rate of detention and, within that, decrease the racial disparities, such as the fact that a black person is four times more likely to be detained than a white person. There are a number of things that I hope we will be able to discuss more, particularly in the debates on Thursday as well, such as the things we have introduced in pilots, like the culturally appropriate advocacy. That really can make a difference here and now.

Adult Social Care (Adult Social Care Committee Report)

Lord Bradley Excerpts

Monday 16th October 2023 Lords Chamber

[Lord Bradley (Lab)]

My Lords, as a member of the Adult Social Care Committee, I welcome this debate on our report and add my praise to the chair of the committee, my noble friend Lady Andrews, for her wisdom and guidance throughout. I also refer to my interests in the register.

Time is short, so I will limit my contribution to just a couple of our key recommendations. But I start by quoting the very beginning of our report, which posed the question:

“Why should we care about adult social care?”


The blunt answer is that

“it concerns all of us”.

In our lives we are likely to need that support, or to care about someone who does. It

“affects the lives of over 10 million adults of all ages in England at any one time”.

In recent years, driven by the consequence of an ageing society and the cost of residential care, together with the challenges of funding and staffing, the increasing demands on adult social care have rightly forced it up the political agenda. Tragically, though, despite a raft of reports, research papers, White Papers and legislation, very little has improved for those who depend on and provide adult social care. As we said in our report:

“Many aspects of the system remain invisible and overlooked by the public and policy makers alike”.


This is particularly true of unpaid carers, which is why we put a spotlight on them in the report—people with lived experience of the current system.

Our report said:

“We heard the frustration and anger of those who have to battle to access even the most basic support, and who have experienced adult social care becoming ever-more distanced from a service that might enable them to live a life of their choice.


We also heard the testimonies of unpaid carers, the often invisible spouse, child, parent, sibling or friend who has to step up to provide care and support when the system is failing”.


These moving testimonies by individuals and the many wonderful organisations that try to help and support them were not made through bitterness but from a loving and caring perspective, simply asking for help and recognition of the dire and exhausting plight they often find themselves in currently.

It is against this background that the committee made its recommendations. I highlight just two tonight. First, the committee recognised that while a stronger, more resilient and integrated care sector is needed at the local level—and I believe the integrated care boards and systems must make this an absolute priority and drive this agenda forward—

“we also believe that some new and effective national leadership that focuses attention on adult social care is urgently needed”:

a real champion for social care. As Sir Andrew Dilnot described it to us, we need

“a single person whose job it is to think or worry about social care and do that publicly”.

The committee believed that:

“One effective way of doing so would be to establish a Commissioner for Care and Support, tasked with acting as an effective champion and upholding the rights of disabled adults and older people, as well as unpaid carers. The Commissioner would also embed more accountability and challenge in the system”.


What was the Government’s response to this recommendation? They said they believed that

“new statutory roles are not the most efficient way to promote and protect the rights of these groups. The duties covered by such a role are covered by work elsewhere in the system”.

To say that this response is disappointing would be a massive understatement. I do not believe that, for example, the excellent work of the Children’s Commissioner, if abolished, would be well covered elsewhere in the system. The Children’s Commissioner ensures an independent focus on the needs of children, and adult social care deserves the same focus. When he replies to this debate, will the Minister explain where the efficiency, transparency, accountability and, crucially, independence is clear in the current system?

Secondly, and very briefly, I will address our recommendations to review the care allowance, which the noble Baroness, Lady Andrews, touched on. It currently does not reflect in any way the real value of unpaid carers. In my view, it is unacceptable that this is the lowest benefit of its kind, exacerbated by the threshold of caring hours and the low and inflexible earnings limit.

The Government’s utterly complacent response is to say:

“The government keeps the earnings limit under review and considers whether any increase in the limit is warranted and affordable”.


I believe that this is disrespectful to the millions of unpaid carers, without whom this care system would collapse and who need crucial financial support now. Their caring responsibilities often arise through an unforeseen incident or circumstance, such as a sudden diagnosis of chronic illness, a devastating accident or a stroke, so dramatically undermining household income or long-term financial and pension planning. I urge the Minister to reflect on this and respond accordingly tonight.

Nursing Courses: Reduction in Applications

Lord Bradley Excerpts

Tuesday 19th September 2023 Lords Chamber

[Lord Markham (Con)]

Yes, my understanding is that all the workings behind the long-term workforce plan are currently being analysed by another body— I am not quite sure whether it is the NAO, the ONS or whoever. The point is that all the modelling and the underlying assumptions are being analysed, and I believe there will then be a report on them so that everyone can see what we are trying to do and how reasonable those assumptions are.

[Lord Bradley (Lab)]

My Lords, the University of Salford, where I am chair of council, has seen applications for adult nursing down by 28%, children’s nursing down by 27% and mental health nursing down by 6%, with an overall drop of 23%. From the feedback the university is receiving, the main barrier is that the financial support needed to undertake a highly intensive course, which leaves little time for part-time working, is insufficient to meet the current cost of living. Does the Minister accept that this is a factor in the drop in applications, and will the Government review the financial package of support available to nursing applicants to ensure, as we have heard, that the NHS workforce plan is deliverable?

[Lord Markham (Con)]

Clearly, as the largest employer in the UK—if not most of the world—the NHS always has to be looking at the whole package that it is offering its staff to make it an attractive place to recruit good talent and retain it. The point that the noble Lord makes is absolutely correct, and those are all things that need to go into the mix. As I say, recent data is encouraging. We have increased the numbers by 45,000 and are on course to hit the 50,000 target, but, as ever, we need to be vigilant because we want to recruit a lot more.

Mental Health In-patient Services: Improving Safety

Lord Bradley Excerpts

Monday 3rd July 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness. The points she rightly makes are exactly what we believe is the remit of the new HSSIB review starting from October. One of the specific points is about developing safe therapeutic staffing models for all mental health in-patient services. I think and hope that the exact points raised by the noble Baroness will be addressed by the review.

[Lord Bradley (Lab)]

My Lords, the Government’s draft mental health Bill proposes—and I and the Joint Committee support this—the banning of prisons as a place of safety and the transfer of patients within 28 days of the mental health assessment to a safe mental health secure unit. Will the Minister ensure that this is included in the national review, so that there are sufficient local safe secure facilities to implement the 28-day recommendation and that these patients are cared for in genuine places of safety?

[Lord Markham (Con)]

I understand the concern brought, quite rightly, by the noble Lord. It would be best for me to write on that, so that I can give the specific position and he can have the detail he requires.

Social Care

Lord Bradley Excerpts

Thursday 30th March 2023 Lords Chamber

[Lord Bradley (Lab)]

My Lords, as another member of the Adult Social Care Committee and declaring my interests in the register, I am pleased to make a short contribution to this very important debate. I too congratulate my noble friend Lady Andrews on securing this debate and, more importantly, I praise her knowledgeable and passionate chairing of the committee and her opening speech today, which I fully endorse.

The evidence we received throughout our inquiry was for recognition and support for social care in general and unpaid carers in particular, as a largely hidden workforce. The evidence was compelling, inspiring but also at times harrowing, and I praise all the contributors. As the committee stated at the beginning of our report:

“Creating a sustainable social care system in which people, their families and friends can thrive is a national imperative”.


A sustainable adult social care service must be seen as

“an indispensable partner to the health service”

and clearly and genuinely integrated with it. Surely no one can disagree with that. As we further noted, the new integrated care boards and systems must be at the forefront of realising this ambition.

As we have heard, to achieve it, investment and resources must be forthcoming. Again, the committee made clear that the Government must increase the financial settlement for adult social care over three years and then commit to sustaining realistic, long-term and protected funding for the sector to enable the robust planning of services. So it was clearly disappointing that there was no mention of sustained funding in the Budget, or any recognition of the need to reform the social care funding system based on the laudable principles established by the Dilnot inquiry.

Linked to this funding settlement is, as we have heard, access to the key benefit for carers—carer’s allowance. It is the lowest benefit rate of its kind—I do not apologise for repeating that—and it is not reflective of the extraordinary value of unpaid carers, as we have already heard today. Some of the most shocking evidence we heard from unpaid carers was about families’ lives being suddenly and unexpectedly overturned by some catastrophic event, perhaps a critical or terminal illness or a life-changing accident, with their immediate income and long-term financial planning in absolute turmoil.

So access to carer’s allowance must immediately be made easier by lowering the threshold of carers’ hours and ensuring that the earnings limit is uprated in line with the national living wage and in law. Further, the DWP should fundamentally review the carer’s allowance and report back to Parliament within one year to give some hope of financial support for this army of unpaid carers—I would be very grateful for the Government’s views on that today.

Touching very briefly on workforce, we wait expectantly for the Government’s social care plan and the workforce proposals within it. The current situation of low pay, limited career opportunity and thousands of vacancies in the sector is an utter disgrace. The committee’s recommendation that the Government must produce, with people who work in and draw on adult social care, a comprehensive, long-term, national workforce and skills plan, is an absolute priority.

Finally, it is essential that a laser focus is maintained on adult social care, and particularly on the incredible work and dedication of unpaid carers. To this end, the committee strongly believes in the establishment in the next 12 months of a commissioner for care and support to act as a champion for older adults, disabled people and unpaid carers. Critical early priorities for such a commissioner would be to include oversight of a government-commissioned, independent public review of the Care Act 2014, working with local authorities to ensure that the Act is fully implemented, and also to set up, as we have heard, the identification of the millions of invisible unpaid carers, perhaps through NHS patient records—with their permission—to ensure a mechanism to provide carers with information, self-care and digital resources to support them. They deserve nothing less.

Adult Social Care

Lord Bradley Excerpts

Monday 20th February 2023 Lords Chamber

[Lord Markham (Con)]

Absolutely, and that is the whole intention behind the ICSs: the ability in their areas to know local needs and invest in the right places—that is, in social care rather than having people in beds in hospitals, because it is a much more effective use of resources, and also in primary care. We all know that a lot of people go to A&E because they have not got primary care services, so the whole point of the ICSs is that they start to invest where demand is in the area, rather than using hospitals as the place of last resort to go to.

[Lord Bradley (Lab)]

My Lords—

[Lord Forsyth of Drumlean (Con)]

My Lords—

[Baroness Williams of Trafford (Con)]

My Lords, there is plenty of time for both.

[Lord Bradley (Lab)]

My Lords, I too was a member of the Select Committee. One of the other key recommendations of our report was the establishment of a commissioner for care and support, to act as a champion for older adults, disabled people and, crucially, for unpaid carers, and that we should prioritise to ensure a review, update and implementation of the Care Act. Do the Government support these proposals?

[Lord Markham (Con)]

Again, we welcome the report and many aspects of it. What I and my ministerial colleagues care most about is having the results and the impact. I think—and hope that noble Lords will agree when they see the work that she is doing in this space—that Minister Whately is gripping it and providing results. Let us see how that progresses first, because I think that that will have the impact that we need.

Mental Health Act Reform

Lord Bradley Excerpts

Thursday 26th January 2023 Lords Chamber

[Lord Markham (Con)]

No, I hope that all noble Lords will see that there is no sense of delay on this side—and we are not waiting for the legislation to introduce a lot of these measures. It is very important, and we are ready to push on as soon as parliamentary time allows.

[Lord Bradley (Lab)]

My Lords, declaring my interests in the register, particularly as a trustee of the Centre for Mental Health and a member of the Joint Committee, perhaps I might press the Minister on one of our key recommendations: to establish a statutory mental health commissioner to oversee the implementation of the draft Bill, which we fully support, and to have a laser focus to ensure consistency across the country in the services required, underpinned by investment in community services. Unless those are forthcoming in a timely way, the Bill’s intentions will be undermined. Will the Minister confirm today that he will accept the recommendation for a mental health commissioner?

[Lord Markham (Con)]

I hope noble Lords accept that the report came out only last week and we need a little time to consider it. What I can say is that we are all focused laser-like on making sure that change is happening in this space. If the best way to do that is by appointing a mental health commissioner, that will have my support. At the same time, I am very aware that ICBs are responsible for this, and I want to give them the space to make sure they can properly manage mental health and other health services in their area.

Health and Care Bill

Lord Bradley Excerpts

Consideration of Commons amendments
Tuesday 5th April 2022 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, as others have spoken fully to other amendments in this group, I will confine my remarks to Motion L1 in my name. I thank the Minister for the open-door policy that he has had and for his willingness on many occasions to discuss with me the problems for parents who can feel completely overwhelmed in the face of not being listened to by clinicians. I am also particularly grateful to the noble Baronesses, Lady Brinton, Lady Masham and Lady Stowell, for their helpful comments and advice behind the scenes, and to the noble Lord, Lord Balfe, who has shared with me his extensive experience on mediation.

In drafting my amendment to the amendment, I was particularly concerned that we must take evidence directly from parents, including parents whose dispute has not necessarily progressed to court. While it is quite extreme to progress as far as court, there seem to be a lot of parents who have felt completely overwhelmed in the face of personal tragedy. In an interview, Rob Behrens, the Parliamentary and Health Service Ombudsman, said about mediation:

“We’ve got to get better at communicating with complainants, better at learning from bad experiences, and better at using early resolution and mediation so that sometimes we don’t have to use adjudication at all.”


He went on to point out some of the cultural characteristics of the health service that make these encounters hard. He listed professional dominance, clinical hegemony, hierarchy and defensiveness as characteristics that make it particularly difficult.

I am grateful to the noble Baroness, Lady Pitkeathley, for flagging up parent carers. They often feel deeply disempowered because they are completely dependent on the help of others to manage a very difficult situation and so particularly inhibited in the face of any professional dominance; of course, there have been some stories in the press.

In response to the Minister, I will gladly be involved in developing the scope of this review. I hope that he will rapidly put me in contact with the official who will be responsible for it because we need to start as soon as possible. The government amendment stipulates a year—actually a very short time to run an inquiry—so it needs to happen quickly. I hope that there will be funding resources attached to this; it cannot be done on thin air or a shoestring. I hope also that there will be support for it to be done properly so that we can take evidence. Developing the scope of the review will be very important and I think there are parent groups who would particularly wish to be consulted at that early stage as well.

In the letter that we were sent, I note that the Government said:

“Should the review make recommendations for legislative change, and the Government agrees with those recommendations, we would seek to bring forward legislation where parliamentary time allows.”


I see that the Government have left themselves a small out, but, if this is to be a properly conducted review with clear recommendations, I hope that they will listen to that evidence and will not shirk at taking whatever steps are necessary.

I conclude simply by thanking the Minister, the Bill team and the other officials who have engaged in many hours of discussion on this issue. I look forward to working with speed on getting this review up and running.

[Lord Bradley (Lab)]

My Lords, I will speak very briefly to Motion Q: Amendments 105 and 105A. I declare my health interests as in the register, particularly my role as a trustee for the Centre for Mental Health.

I was disappointed that the Government did not accept my Amendment 105, which was passed in this House on Report, regarding mental health membership on integrated care boards. I repeat my thanks for the support I received for the amendment from Labour and Liberal Back-Benchers, particularly the noble Baroness, Lady Walmsley, some Cross-Benchers, and from my own Front Bench, my noble friends Lady Wheeler, Lady Merron and especially Lady Thornton, who has been tremendously supportive throughout. I am also extremely grateful for the continuing and unstinting support of organisations outside Parliament, such as the Centre for Mental Health and the Mental Health Foundation.

However, I am satisfied that the Government’s amendment in lieu, Amendment 105A, captures the essence of my amendment: that the voice of mental health should be at the board table at the inception of the 42 ICBs, and play a crucial part from the start in determining service priorities, budget and resource allocation, workforce growth and development, and commissioning arrangements, among other things. The chairs of ICBs will now have responsibility for the appointment of mental health representation and will be held accountable for their decisions. This House, the other place, external bodies, the public and I will all scrutinise these appointments very carefully.

The Government’s amendment, devised by the noble Baroness, Lady Walmsley, and passed on Report, will put a double lock on mental health representation because of its intention to review the skill mix and expertise of ICB membership in the future. We had further assurance in the Minister’s letter to all noble Lords, which said:

“We strongly agree with the principle underpinning Lord Bradley’s amendment and with his view that ICBs will be strengthened by having at least one member with knowledge of Mental Health on the Board. As it stands, however, the current drafting would create significant legal ambiguity, which is why we tabled an amendment in lieu in the Commons to ensure that the principle is maintained in a legally robust way”.


I am grateful to the Minister for this assurance, and I believe that in taking it together with the two amendments, the ambition for parity of esteem between physical and mental health will, as a result, take a further significant step forward.

The Government’s amendment in lieu of my amendment should ensure that the voice of mental health is heard clearly on ICBs and in the wider integrated care system, and that the mental health and well-being services needed and demanded by the public are at the heart of integrated health policy in the future.

[Lord Balfe (Con)]

My Lords, I rise to speak to Motions L and L1. Where we have got to today is a good example of what the House of Lords is for. When this Bill came to the Lords it had nothing in this area—but by working together, particularly with my friend, the noble Baroness, Lady Finlay, we have produced an acceptable clause. I would have liked more, but it is acceptable.

My skill, so to speak, was mediation, not health. What I hoped to do was to alter subtly but importantly the power relations in the hospital setting. The aim of compulsory mediation is that the patient would be given some power, although only the power to ask for mediation, which is, after all, a system whereby both sides have to agree. None the less, it would give them a way of articulating an issue. One of the jobs of a mediator is to make sure that both sides of any case are understood not only by the other side but by the side presenting it. I did the odd mediation in my time, and when we got down to it, it was clear that the people asking for it were not quite sure what they were asking for. So mediation is a way in which to calm things down, and that is what I was hoping to do. In the middle of all this, the Ministry of Justice came forward and said that it would cover certain legal costs. My aim was actually to reduce costs on the NHS by producing a rather cheaper way—but I am sure that that is something to be welcomed.

I will make just two or three small points. First, when this review is done, it is important that the mediation system that comes out is capable of being enforced. There are basically two types of mediation—what in lay man’s terms we used to call family mediation, and commercial mediation. The weakness with family mediation was that it was non-binding. I never did family mediation, but I belonged to a group with both sides in it, and one of the most distressing things was the huge amount of time that could be put in, and then the mediation agreement was just renounced and set aside. That has to be avoided; we cannot be in a situation where there is an NHS mediation and, let us say, the senior consultant says, “I’m not having that—I refuse to agree.” There has to be something equivalent to what in commercial mediation is known as the Tomlin order, which is the order whereby the court underwrites the mediation; it does not intervene in it but it gives it the force of law so that it can be enforced.

The detailed points that I would like to make to the Minister are as follows. First, in the clause that he has tabled, the department refers to

“the carrying out of a review into the causes of disputes”.

It needs to go a bit wider than the causes; it needs to be a review into the causes and the ways of solving disputes. It is no good having a catalogue saying, “This is where there are disputes.” It has to actually provide a solution to the disputes.

My second point is about where the provision refers to

“a report on the outcome of the review, within one year beginning with the date on which this section comes into force.”

It is a very simple question here: when does the Minister envisage that the section will come into force? There are things in Acts that have been around for years and which have never actually come into force. When will this come into force? I also hope that he will be able to give us a favourable answer on Motion L1, and the additional amendment, tabled by the noble Baroness, Lady Finlay. It adds a couple of very important points to this amendment, and I hope that it will be accepted.