Mental Health Bill [HL]

Lord Bradley Excerpts

2nd reading
Monday 25th November 2024 Lords Chamber

[Lord Bradley (Lab)]

My Lords, it is always a pleasure to follow the noble Baroness, Lady Hollins, with her expertise in this area. I declare my interests as listed in the register and am pleased to make a short contribution to this debate. It has been some time coming.

Following the excellent review of the Mental Health Act, initiated by the noble Baroness, Lady May, Sir Simon Wesley produced his report in 2018 and a draft Bill was published by the last Government, as we have heard. This was followed by detailed scrutiny by the Joint Committee of both Houses, which I was pleased to be a member of and which was so admirably chaired by the noble Baroness, Lady Buscombe. It was disappointing at that point that the deliberations were paused, but I was delighted that the new Government, following a manifesto commitment, immediately introduced this Bill, which everyone has welcomed today.

In the time available I will focus on only a few areas, the first of which is the proposed changes under Part 3 of the Bill—essentially, the interface between mental health and the criminal justice system. I am delighted that Clause 35 proposes a statutory time limit of 28 days for the transfer of acutely mentally ill patients held in prison to appropriate hospital provision. It is now well recognised that the prison environment and care capacity is detrimental not only to the prisoner but to other prisoners and the staff who care for them. I made a similar recommendation in my independent report to government in 2009, nearly 16 years ago—albeit with the perhaps unrealistic time limit of a 14-day transfer. Clearly, you have to be patient and persistent to achieve legislative change.

Secondly, on Clause 46 and the removal of police stations and prisons as places of safety, I made related recommendations back in 2009, and I am obviously now pleased that there is overwhelming recognition that both facilities are not appropriate as places of safety. Clearly, detailed examination of these proposals will be required in Committee to ensure that the wording delivers their intention. For example, when will the clock start on the 28-day limit?

Thirdly, for this to be effective, investment in alternative community-based healthcare provision will be required for places of safety, as will investment in liaison diversion services, to ensure that only those who need to obtain a place of safety. Otherwise, as we have heard, A&E departments will continue to be the default position, at huge cost to the NHS and to the police service. We also need additional acute mental health beds in every local area to ensure timely transfers and to make the legislative changes a reality.

There is also concern, well articulated by the Children & Young People’s Mental Health Coalition, that children and young people are still inappropriately placed in settings outside their local area, and on adult wards. It is imperative that the Bill strengthens safeguards against this and recognises the Joint Committee’s recommendation for stronger procedural requirements where such inappropriate placements are considered, including a requirement that such a placement is demonstrably in the child’s best interest.

There are many positive elements of the Bill, as the Minister clearly outlined in opening this debate, including improving the patient experience, improving patient choice and autonomy, and limiting the detention of people with learning disability and autistic people without qualifying co-recurring mental health conditions—all of which and much else, as we have heard, will be carefully considered in Committee.

However, I believe we need further debate on where the principles outlined by Simon Wessely are placed in the Bill. I am particularly disappointed that the Government have not currently accepted the recommendation to establish the role of a mental health commissioner and seemed silent on the issue when the Bill was introduced. As we have heard, the Joint Committee recommended that this post be statutorily positioned and that the mental health commissioner should be created with a number of roles, which I would like to briefly elaborate on.

The mental health commissioner should be a voice at a national level, promoting the interests of those who are detained and who are likely to be detained under the Mental Health Act, as well as the interests of their families and carers, raising awareness of their needs and challenging stigma and stereotypes. They should work in conjunction with the Care Quality Commission and other bodies to make recommendations on further reforming mental health law in the direction of more rights-led and fused legislation, such as we have heard on the Mental Capacity Act.

Critically, the commissioner should be a mechanism for tracking the implementation of the reforms in and associated with this Bill and other legal changes, essentially and particularly with the inclusion of the provision of data to understand how the Bill is operating. We saw the role of the commissioner as primarily to act as a watchdog to oversee the direction of travel for the key reforms in the Mental Health Act and mental health policy generally, overarching the whole government system. This has been supported by many organisations working in the mental health field, including the Centre for Mental Health, of which I am an ambassador. The centre added that, in addition to overseeing the reforms to the Mental Health Act, a commissioner could play a wide-ranging strategic role across all government departments.

Finally, I will say a few further words about resourcing and implementation, which will be crucial to the success of this legislation. Again, the Joint Committee recommended that the Government publish a comprehensive implementation and workforce plan alongside the Bill with key milestones detailing the implementation of the Bill and, crucially, how they link to milestones in the implementation of the NHS 10-year plan and other government initiatives. These should include milestones on workforce development, not only for mental health staff but allied health professionals, such as speech and language therapists. I declare my interest as honorary vice-president of the Royal College of Speech and Language Therapists.

The plan should also include milestones on training, advocacy and community care capacity, as well as on numbers of detentions, length of stay and, critically, reducing racial and ethnic inequality. There should also be a statutory duty to report annually to Parliament on the progress against these milestones during the implementation period. Disappointingly, unless I have misunderstood the Explanatory Notes to the Bill, the Government have so far offered only a financial assessment over a 20-year period, which is not at all coherent with the NHS 10-year plan.

However, in conclusion, I am very pleased that we are debating this incredibly important Bill now and in the coming weeks and months to try to ensure that we go a long way to producing a progressive Mental Health Act which is fit for 2025 and years beyond. I look forward to the Minister’s response at the end of the debate.

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.