Mental Health Bill [HL]

Debate between Lord Bradley and Baroness Tyler of Enfield

Committee stage
Monday 24th February 2025 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I am sorry, it is me again. My Amendment 131 would establish a mental health commissioner for England as a new statutory office within government. I am quite conscious that it is a rather long and detailed amendment, but to my mind that reflects the importance of it to the successful implementation of the overall Act and the pivotal role that a commissioner would play. I am very grateful to the noble Lord, Lord Bradley, and to the noble Baronesses, Lady Murphy and Lady Bennett, for adding their names to my amendment, which gives a sense of strong cross-party support.

The Joint Committee recommended the creation of a statutory mental health commissioner to help drive the ongoing process of system reform and ensure accountability for implementation—I always felt that that was one of its seminal recommendations. I believe a mental health commissioner would provide sustained leadership for mental health, complementary to the existing roles and structures that we have, as well as monitoring the effective implementation of the Act. The commissioner would operate inside government and in the wider public sphere, giving the role real teeth.

Yes, the commissioner would have influence within government and the NHS, but they would also have the freedom to speak out when they considered it necessary to lead public debate, challenge stigma and break down boundaries and taboos. They could help galvanise action across departments and systems to improve population mental health and ensure that people living with mental illness are treated fairly and equitably in every sphere of life. In short, the commissioner could bring about a much-needed transformation in our mental health services. By establishing the role in statute, we would ensure that mental health would no longer be a topic that waxed and waned in its profile and importance within government and was reliant on either short-term interest or sometimes very hard-won attention.

Reflecting on the very important debate we had on reducing racial inequalities, I would consider that both assessing and taking action on inequalities in mental health would also be a critical role for the commissioner. Such a commissioner would be well placed to take responsibility for the oversight of a new responsible person role for addressing and reporting on racial disparities in mental health units at local level, as we discussed earlier in the debate on my Amendment 133.

We have an excellent example and model to follow in the way the Children’s Commissioner operates. From my extensive work on children’s issues over the years, I know how effective and influential that role has been, particularly during a period when there has been a change of Government. It has genuinely shifted the dial. I get the fact that it may not always feel 100% comfortable for the Government of the day, but they should embrace and welcome the additional scrutiny, ideas and recommendations that are based on engaging directly with people with lived experiences about their concerns.

That is certainly how it is happened with the Children’s Commissioner, who I think has done excellent work on children’s mental health. I know that it has proved to be empowering for children and young people to feel that their voice is being heard at the top table. I want that same opportunity to be in place for people with mental illness. It has the potential to make this Act a truly ground-breaking piece of social reform.

Mental health commissioners already exist in a number of international jurisdictions, including Scotland, Ireland, Canada, New Zealand and Australia. There is some helpful research from the Centre for Mental Health that shows the value of such roles in other countries.

I feel I can already anticipate the Minister’s response. At Second Reading, the Minister said the commissioner might duplicate the work of the Care Quality Commission. I do not think that is the case, as their roles would be complementary, as the Children’s Commissioner complements the work of Ofsted. The functions of the two are clearly different: they have different powers and responsibilities that between them provide extra benefit to the public that could not be achieved by one of them alone. Both have the powers of entry to inspect services that work with children, but their roles and the outcomes they seek to provide are very different. The Children’s Commissioner has a wide advocacy role across the whole of government, as well as civil society more broadly, so they can act in a way that Ofsted cannot possibly do.

So I very much hope that the Minister will be willing to discuss this with me when we meet later this week and, indeed, with other noble Lords who have expressed support, to discuss how we can really make this fly. I beg to move.

[Lord Bradley (Lab)]

My Lords, I strongly support Amendment 131, to which, as my noble friend Lady Tyler has stated, I have added my name. I can be brief because of the eloquence and comprehensive nature with which she introduced the amendment.

First, to note my registered interests, as this is probably the last day of Committee, the establishment of a mental health commissioner was recommended by the Joint scrutiny Committee of which I was a member. So it was a great disappointment that the Government did not include it in the Bill.

As I said at Second Reading, the mental health commissioner should be a voice at national level, promoting the interests of those who are detained and who are likely to be detained under the Mental Health Act, together with the interests of their families and carers, raising awareness of their needs and challenging stigma and stereotypes. Crucially, the commissioner should be at the forefront of tracking and scrutinising the implementation of these reforms.

There is widespread support for the establishment of the commissioner, both inside and outside Parliament and from statutory, non-statutory and charitable organisations. For example, the Centre for Mental Health, for which I am an ambassador, has stated:

“A Mental Health Commissioner … would offer sustained leadership for mental health—complementary to existing roles and structures in government. They would operate both within the machinery of state and in the media and wider public sphere. They would have influence within government and the NHS, but with the freedom to speak out when necessary: to lead public debate, challenge stigma, and break boundaries and taboos”.


I totally agree with this view. However, in reply to this proposal at Second Reading, supported by many noble Lords, the Minister pushed back on it stating that there are concerns that

“the proposed mental health commissioner’s function would be potentially largely duplicative of existing bodies and functions, and nobody wants to risk diluting accountability or causing confusion”.

The Minister went on to say:

“As noble Lords will know, Dr Penny Dash has been asked by the Secretary of State to assess if the current range and combination of organisations within the healthcare regulation landscape is effective and to make recommendations of what might be needed, and I think it is important that we await her recommendations”.—[Official Report, 25/11/24; col. 584.]


The key word here, I think, is “regulation”, and I do not agree with this view.

Since Second Reading, I have looked at the terms of reference of commissioners and regulators in various areas of public policy, and I believe that these roles are quite distinct. I agree with the noble Baroness, Lady Tyler: the role of the Children’s Commissioner and the separate role of the education regulator Ofsted are a good comparison. I do not think these two roles dilute accountability or cause confusion. Further, I cannot remember if it has ever been suggested that these roles should be amalgamated or that the Children’s Commissioner should be abolished. In fact, I believe that there is widespread support, particularly from the public, for the invaluable independent work undertaken by a Children’s Commissioner.

I also think the Minister herself has made a very persuasive case for a mental health commissioner in her many constructive responses to the amendments already debated, especially today. My noble friend has noted, among other things: the complexity of the legislation and its interrelationship with the Mental Capacity Act 2005, the need for significant investment in community services, the development of a skilled and complex workforce, and the number of years it will take to implement all the provisions of the Bill. This will need rigorous, robust and consistent oversight of implementation and wider health policy and service developments over the next decade and beyond.

The establishment of a mental health commissioner will ensure transparency and accountability and introduce a real force for good for the development and delivery of high-quality mental health services across the country. I hope the Minister will now agree and support this amendment.

Mental Health Bill [HL]

Debate between Lord Bradley and Baroness Tyler of Enfield

Committee stage
Monday 27th January 2025 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I will just add a couple of brief points. This is a really important set of amendments and the issue of making it easier to transfer people between prisons and hospitals is critical. If you like, it is at the heart of some of the reforms that we are looking at. I have a lot of sympathy for the amendments put forward by the noble Lord, Lord Bradley. I am also aware that he has waited a very long time. Did he say that it was 28 years?

[Lord Bradley (Lab)]

Sixteen.

[Baroness Tyler of Enfield (LD)]

Just the 16. Anyway, it is a long time to wait.

The amendments aiming to make it clear, as the noble Lord said, when the clock starts ticking are really important, so that there is real accountability injected into the system. Often, when things go wrong it is where no one really feels responsible for something, so it does not happen. I will also be interested to hear what the “exceptional circumstances” do and do not include—I hope we will get some examples—because if they include just things such as shortage of staff or beds, we will not get very far at all, given the current state of mental health beds.

I understand the rationale behind the amendments tabled by the noble Lord, Lord Stevens; the reciprocity is a really important point to make. I just have slight concerns that we might be saying that this cannot happen in the way that the noble Lord, Lord Bradley, wanted to see, because we know that we have not got the scarce and specialist beds. They are just not available; it is very important to be practical about it.

It comes to the heart of the matter of this whole Bill: we know that, unless proper resource is put into the implementation of the Bill, it is not going to work at all. We know that, with mental health provision, particularly a secure unit, particularly with the state of the estate, the shortage of staff and all of that, there has to be wholesale investment in it for these things to work. I think the time has come. I simply add my voice to others to say that I hope the noble Lord practises patience—but I think he has waited long enough so I hope his patience will not be tested any longer.