Mental Health Bill [HL]

Lord Davies of Brixton Excerpts

Committee stage
Wednesday 22nd January 2025 Lords Chamber

[The Lord Bishop of Manchester]

My Lords, I support all the amendments in this group. I also want to communicate the support of my right reverend friend the Bishop of London, who apologises that she cannot be in her place this evening.

Turning to the amendments led by the noble Baroness, Lady Whitaker, on culturally appropriate care, I appreciated the noble Baroness’s references to the Gypsy, Roma and Traveller community. I have worked with that community much over many years and very much enjoyed my interactions with it.

These amendments highlight issues that my right reverend friend has spent a lot of time considering, particularly from a faith perspective. I do not think we have heard that in the debate so far tonight. It is sometimes hard to grasp just how differently our health, especially our mental health, is culturally understood across different communities and faith groups. While our ability to discuss our own and others’ mental health may be generally improving—I think it is—it remains an extremely difficult discussion point for many cultures and many communities.

When you combine that with the extensive inequalities of outcomes that we find, and many people’s experiences of culturally inappropriate care in mental health and other settings, it is inevitable that many people are reluctant to engage with preventative services. It was said at Second Reading that minoritised communities are likely to engage at a crisis point rather than seek early interventions. My wife worked for many years as a maths specialist in the home and hospital tuition service of a large urban authority. She regularly found that she was working with pupils whose mental health needs had been picked up late, if at all, because the culture of the parental home saw mental health issues as shameful, and not something you could raise with external service providers. So culturally appropriate care is a crucial step if we are to build the trust that is ultimately vital to reducing health inequalities.

In order that culturally appropriate care is deliverable, training on faith literacy, as well as different cultures and beliefs, will be crucial. Again, I have found that myself; I have been working with my fellow faith leaders in Greater Manchester, including the excellent Caribbean and African Health Network. I make no apology for banging on about religious literacy in your Lordships’ House on yet another occasion: it does really matter. Service providers in all sectors do us a huge disservice when, through their own faith illiteracy, they operate with a presumption that religion matters only in the realm of private affairs. Getting it right in this Bill will of course necessitate additional resource. In supporting these amendments, I hope that sufficient resources will be allocated to this work.

I turn finally to Amendments 65, 133 and 138, in the names of the noble Baroness, Lady Tyler, and the noble Lord, Lord Kamall. I am a statistician by background. We know the importance of good and useable data to ensure that we have an understanding not just of the gulfs of inequality of outcomes but of the more nuanced and complex patterns that lie underneath them. Amendment 133 recognises the need for regular training and has a consultation element as part of the policy. I hope this will be taken up and I hope that will include consultation with faith groups. We must commit to work with such groups to build trust with communities that service providers are wont to call hard to reach. I do not believe we should call any group in our society hard to reach. What we do have, all too often, are service providers who just do not make enough effort to reach. So instead, let us work with organisations such as CAHN, which I mentioned earlier, to ensure earlier interventions than those we often see.

I also warmly welcome Amendment 138, which, as others have said, highlights an appalling scandal in our society. I thank the noble Lord, Lord Kamall, for tabling that amendment.

[Lord Davies of Brixton (Lab)]

I know the hour is late, but I want to note the irony that the issues covered by these amendments are central to the whole process of why we have arrived at this Bill. In a sense it is unfortunate that, because of the hour, there are so few of us present. I want to stress that we cannot assume it is job done. It is really important to keep this whole area under review, whether we do it precisely in the terms of the amendments before us or not. I urge my noble friend the Minister to give an assurance that this issue will not be left for another 17 years before we decide that we have got it right, and that the workings of the Bill in this central area will be kept under close and continued review.

[Baroness Berridge (Con)]

My Lords, I will speak briefly in support Amendment 133. I know the hour is late. As I asked the Minister, why is it that issues relating to this focus, which was the focus of the Bill, seem always to end up at the end of our debates? I am not sure why, but they are some of the most important issues. I reflected at Second Reading and earlier in Committee on the Joint Committee’s work and our concern about the strength of civil society and media focus on this issue. Although what we saw seemed expert, we then saw a comparison with what I would call Premier League—which was learning disabilities and autism in terms of that focus.

I turn to new Section 120H, which the noble Baroness, Lady Tyler, mentioned, and the statistics I cited before. The right reverend Prelate mentioned the importance of data. It is very concerning that, when we talk about the data on under-18s, we are not quite clear about what is going on in relation to it. The data on under-18s that I mentioned has three subgroups: those who are detained, those who are in the cohort because their parents have consented and those who have consented themselves. It is imperative that we know exactly which subgroup is which in the under-18s group—which, thankfully, is a small group of about 1,000.

Even in the data I cited from the UCL study, of the 23.6% of under-18s that were detained, three times as many black young people were detained as their counterparts. That issue is starting early. What is happening even at that early stage—the disproportionate number detained under the Act—was also reflected in the data on the lack of parents consenting to children going into hospital for the treatment that they need.

Mental Health Bill [HL]

Lord Davies of Brixton Excerpts

Committee stage
Monday 20th January 2025 Lords Chamber

[Baroness Barker (LD)]

My Lords, in speaking to my Amendment 49A, I thank the noble Baroness, Lady May, for her amendments. Those of us on the joint scrutiny committee spent a lot of time focusing on the fact that, in truth, a lot of what happens to people who are having mental health crises depends entirely on where they are, who is there and who somebody passing in the street and tries to help them thinks is the right person to call at a moment of emergency.

We are all in agreement that the police have for too long been the default answer to a problem but are not the right answer to a problem. The police know they are not the right answer to a problem—I say that as somebody who has lots of police officers in my family. A lot of people having a mental health crisis will end up in A&E just because the lights are on and that is where people go. We are still dealing with one of the problems the Wessely review touched upon, and that is lack of timely access to an accurate diagnosis.

My amendment, which I admit was suggested by practitioners in the field, tries to deal with the fact that we do not have an abundance of consultant psychiatrists who are there at the drop of a hat to make assessments. The amendment probes whether we might help things by opening up the eligibility to make diagnoses under Section 12 to people who are health professionals but not necessarily medical practitioners. Back in 2006-07, we had the massive argument about bringing in approved mental health professionals. That was a big battle and there was a lot of rearguard action on the part of consultant psychiatrists, who saw it as a downgrading. Approved mental health practitioners are now very much part of our mental health services and they are a good part of our mental health services.

The amendment is trying to open up the making of assessments, simply in order to speed up access to appropriate services. We all understand, and are talking about, the fact that, although we can see the effects of waiting lists and so on on physical health services, waiting lists and the lack of access to appropriate treatment in mental health services are much more hidden. People end up in limbo unless and until there is some kind of outrage, or, to go back to the noble Baroness’s point, until they do something sufficiently serious.

We ought to be freeing up the capacity of consultant psychiatrists in particular, because not only is demand growing but there are also particular areas of specialist demand—young people with eating disorders, for example. I frequently hear of worried parents being told that their children are not sufficiently ill to get treatment. They are not alone; there are other people in that same situation. My modest amendment is an attempt to open up and make better use of the skills we have within the NHS workforce.

[Lord Davies of Brixton (Lab)]

This is the first time I have spoken in Committee on the Bill, so I declare my interest as a member of the advisory panel of the Money and Mental Health Policy Institute. I shall speak to my Amendment 158, which, as the noble Baroness, Lady May of Maidenhead, said, covers essentially the same ground as hers, and they both aim at the same endpoint. Her elegant and compelling speech has left me in the position of just having to emphasise issues; the case made was compelling, and I hope the Committee will agree. In particular, I hope the Minister will be able to make some sort of positive response.

This proposal does not flow specifically from the independent review, but it is in the spirit of what was in that review. The background to the changing nature of mental health services is the significant material increase in the demand for mental health services over the past few years, and the growing number of people on the mental health waiting list or seeking community support.

This unmet need has consequences, which are felt by front-line medical staff. My amendment seeks to address that by giving additional powers to paramedics and appropriate mental health professionals. It would extend the reach of Section 136 of the Act, currently confined to constables—or police officers, as I say in my amendment. As previous speakers have said, that needs to be shared more widely.

The unfortunate reality of the current situation is that those detained under Section 136 get suboptimal care; we just do not have the resources available for them. There is inadequate provision of suites for Section 136 detention, and there are simply not enough clinicians. We all applaud and support the practice of “right care, right person”, but we must acknowledge that that only increases the demands on the service.

The result of all this is that, as we have heard, police officers are taken away from front-line policing duties for many hours. That is bad for everyone involved—for the police officers, for the health service, and particularly for the patients. At the same time, the skills of non-medical health service staff have increased. They are now moving towards the sort of training that equips them to handle such situations. Obviously, giving staff extra powers will not resolve the situation, but we can learn from experience abroad, especially in Australia and New Zealand, where a range of health service staff have a practice called emergency care orders, with the intention of providing greater dignity, removing the sense of criminalisation, and providing appropriate care.

As my noble friend the Minister said, what we are looking for is beneficial interventions at the earliest possible stage. A key element in achieving that aim is extending the powers under Section 136 to wider professions. That is not to say that there is no role for police officers—there will always be occasions when their intervention is required—but saying that the single source of entry to services of someone suffering an acute mental health problem is through the intervention of the police is just wrong.

There have always been concerns when the powers of medical staff are extended, but this will be an issue of training, guidance and codes of practice—clearly, those will have to be provided—so that the additional powers can be used effectively.

To conclude, I emphasise the point that the noble Baroness, Lady May, made in opening the debate. We have moved beyond the point when the powers in Section 136 were essentially about public order—which is, quite rightly, a role for the police. We must ensure that now, commitments under Section 136 are the first stage of a process of medical treatment, in which the unfortunate individual suffering an acute problem with their mental health must be considered first. This is not about public order; it is about appropriate healthcare, where a range of health service professionals can exercise their trained judgment to the benefit of the patient.

--- Later in debate ---

[Lord Scriven (LD)]

I have listened very carefully to the debate on this set of amendments. Those in the name of the noble Baroness, Lady May, would create a specialism within the relevant professions which is not there at the moment, based on a change of law. The Minister’s response was focused on the skills of people now, based on their generic roles. My question is this: in responding to the noble Baroness, Lady May, did officials and the Minister look at the potential change that would happen to the skill set, and at the skills and professionals that would be specific for this purpose? In practice, if the law changed, that is exactly what would happen to those professions: a subset of skills would develop, which would allow the gap to which my noble friend alluded to be closed.

[Lord Davies of Brixton (Lab)]

With your Lordships’ permission, I want to respond to what the noble Lord has just said. On the front line in this are the paramedics; they are the ones who will have to deal with this issue, most of the time. They need recognition for the additional work that they are already doing. The noble Baroness referred to the gap—the gap is being filled, but in a very inefficient and unrecognised way. We need to recognise that this is something that needs to be dealt with properly, with the staff involved being given the appropriate powers to deliver.

[Baroness Watkins of Tavistock (CB)]

To add to that, the key thing about paramedics is that they do not have long-term therapeutic relationships with the people we are talking about. Therefore, an intervention is totally appropriate.

Covid-19 Vaccination: Coronary Disease

Lord Davies of Brixton Excerpts

Tuesday 23rd April 2024 Lords Chamber

[Lord Markham (Con)]

The main thing that the vaccine did was prevent any bad effects if you did get Covid. While it might not have reduced transmission much, its main benefit was that it reduced the effects if you had it, as well as hospitalisations and deaths. Making Covid a less serious disease, basically, enabled us to open up the country and we were one of the first to get going again because we knew that the disease no longer posed the high risk that it did before we had the vaccines.

[Lord Davies of Brixton (Lab)]

My Lords, I have some personal experience here. One week after I had my first course of Covid vaccination, I had an attack of pericarditis and ended up in St Thomas’ Hospital. I am convinced that there is a link, but it is important to look at the longer-term effects—having an attack of Covid causes more heart problems, as well as having a long-term impact on your general health.

[Lord Markham (Con)]

The noble Lord is absolutely correct. The MHRA study on heart inflammation, which he mentioned, said that there is that side-effect for one to two people per 100,000—unfortunately, the noble Lord seems to have been one of them. However, if you get Covid it affects 150 people per 100,000. On balance, if you have not had the vaccination, your risk is 22 per 100,000. The statistics are very clear.

NHS: Long-term Sustainability

Lord Davies of Brixton Excerpts

Thursday 18th April 2024 Lords Chamber

[Lord Davies of Brixton (Lab)]

My Lords, it is a pleasure and an honour to have been able to listen to this debate. I am happy to come in at this late stage with some additional thoughts. I thank the noble Lord, Lord Patel, for initiating the debate, and all the other speakers. In particular, I congratulate my noble friend Lady Ramsey of Wall Heath.

Putting your name down to speak in this sort of debate means getting a large number of briefing notes. I cannot claim to have read them all. Perhaps the Minister should commit himself to reading all the briefing notes and acknowledge the contribution they have made to our debate. A consolidated version of the notes would be a useful document.

Given the volume of material, there was obviously bound to be much that was missed from our discussions. I will focus my remarks on good mental health. I urge noble Lords to read the briefing notes from both the Royal College of Psychiatrists and the Mental Health Foundation. In the time available, I can touch on only some of the points arising from their submissions, but I think they are important and should be read.

I want to make three points. First, there is a considerable cost of poor mental health. I emphasise that measures are available that can tackle those problems. Providing healthcare is not just about the financial return, but when we can spend relatively limited amounts and get huge benefit, we clearly need to take that into account. Secondly, the focus in this area has to be on prevention. The value of measures aimed at prevention is considerable and will be effective across the whole health service. Thirdly, I mention the importance of undertaking more research in the area of mental health.

I take the opportunity to stress again the importance of getting a mental health Act through the House. Presumably, we will now wait for the next Session. An incoming Labour Government, if we have one, are committed to doing that. The problem is that the problems assessed by Sir Simon Wessely six years ago are still there. The Act is a symbol of the intention to deal with the problems he identified.

What measures could we adopt? What measures do we need to think through? They are all set out in the submissions and there is not enough time to go through them all. Poor mental health among the workforce has been touched on already. According to the research we have been provided with, that is where £1 of expenditure provides £13.62 in improvements. This bears directly on the overall health of our economy. Individual health is very much the health of the economy as a whole. The £118 billion that poor mental health is costing us—that is 5% of GDP—is an obvious and clear target for work across the important area of poor mental health.

National Health Service: 75th Anniversary

Lord Davies of Brixton Excerpts

Thursday 30th November 2023 Lords Chamber

[Lord Davies of Brixton (Lab)]

My Lords, I join other speakers in thanking my noble friend Lord Hunt of Kings Heath for initiating this debate. I am going to focus on the issue of mental health and I declare as an interest my involvement with the Money and Mental Health Policy Institute. My remarks depend a lot on the excellent briefing note produced by the Royal College of Psychiatrists, and there is also the continued information provided by the BMA about the pressures on mental health services in England.

Looking back over the last 75 years, we have seen massive changes in this area. It has improved significantly since the NHS was launched. Treatment options have increased and access to treatment has improved. Most notably, of course, there was the closure of the large institutions—the asylums—and the welcome shift to emphasise treatment in the community. Attitudes have also changed. Social barriers are being broken down, mental health is being talked about more openly and positively than before, and in particular, as has been noted by NICE, young people have a different attitude and will drive the process of achieving progressive change.

Having said that, I endorse the remark made by my noble friend that it is deeply disappointing that we are still waiting for the Mental Health Bill which was first proposed six years ago. Despite all the work that has been done, the issues that prompted the reform process remain unaddressed. Detention rates continue to rise and the detention of black and racialised communities remains hugely disproportionate. I am pleased, therefore, that the Labour Front Bench in the Commons has given a commitment to introduce the Bill in its first King’s Speech, were it to win the next election. I call on the Minister to make a similar commitment. What goes in the manifesto is possibly above his pay grade, but perhaps he can assure us that he will urge it on his colleagues as a priority should we get another term from the Conservatives.

It is worth emphasising that, even without this major legislation, there is much that can still be done to protect people’s dignity, autonomy and human rights when they are subject to the Act. I hope that the Minister will give an assurance that active steps are being taken, failing the Act achieving this objective.

I turn now to where we are and waiting lists, which are highlighted in the Motion. There are a record 1.9 million people currently on waiting lists for NHS mental health services and record numbers of children with a mental illness. One of the main reasons for this is the shortage of staff. We have a workforce plan, but we still lack the ambitious and measurable commitments to expand the mental health workforce, in both hospitals and the community. There are also significant retention challenges affecting the mental health workforce, with professionals reporting high workloads, time pressures and poor work/life balance. Especially, there is the need to address racism and discrimination in the workplace, as well as recruitment.

The problems with staffing result, inevitably, in long waits in A&E, reflecting the difficulties that people have in accessing in-patient provision or community-based crisis alternatives. On top of this, adult acute bed occupancy has not fallen below 95% since May last year. Unfortunately, one of the reasons for this is that more than one in 10 people occupying an adult acute in-patient bed are clinically ready for discharge, but, due to a lack of social care and housing support, they remain in hospital. It also means there is still an unacceptable level of inappropriate out-of-area placements, so perhaps the Minister could say something about that.

There is a special problem with children’s mental health. Over the last few years, we have seen record numbers of children and young people with mental illness. To tackle this problem, it must be recognised that the first five years of life are crucial to a child’s development and to protecting them from future mental health conditions. The Government must invest in early intervention for children and young people—that is widely recognised. The mental health of under-fives should be a priority. The Royal College has identified the need for the urgent introduction of a national network of early support hubs.

Finally, there is the need to address the long-term disinvestment in mental health estates. The mental health sector has some of the oldest buildings across the NHS, with 15% of mental health and learning disability sites built pre-1948—older than the NHS itself—compared to about half of that in the acute sector. Despite this age, and more than 50 bids from mental health trusts for the Government’s “40 new hospitals scheme”, only two were allocated to a mental health trust. Mental health faces the most substantial shortfall in capital investment in cash and percentage terms across all trust types, which is part of a sustained trend in recent years. I hope that the Minister can give us some reassurance in his reply that capital will be put where needed.

Suicide Prevention Strategy

Lord Davies of Brixton Excerpts

Thursday 26th October 2023 Lords Chamber

[Lord Davies of Brixton (Lab)]

My Lords, on the suicide prevention strategy more generally, does the Minister share my concern at the figures published today by the ONS showing that the suicide rate among offenders in the community is six times that of the general population and the suicide rate among female offenders in the community is 11 times that of the general population? Surely this points to the need for priority action.

[Lord Markham (Con)]

The noble Lord is absolutely correct. The priority groups identified include people in the justice system for exactly that reason; likewise, as I mentioned, middle-aged men, who are three times more likely to commit suicide. There is a strategy behind each priority group—people with poor mental health, people on the autistic spectrum, pregnant women, people who self-harm, children and young people, as well as people in the justice system—in terms of how we help and support them.

Adult Social Care (Adult Social Care Committee Report)

Lord Davies of Brixton Excerpts

Monday 16th October 2023 Lords Chamber

[Lord Davies of Brixton (Lab)]

My Lords, it is a pleasure to take part in this debate and I very much appreciate the work of my noble friend Lady Andrews and the committee in producing such an excellent and helpful report.

The big issue, of course, is paying for sufficient care—we have been playing with that issue for 20, 30 or more years—but, short of a grand plan, we can leave that on one side for the purposes of this debate, because, in any event, much can be done. What I would like to stress is the need to take better care of the carers. There is a paid social care service on which there are recommendations that it should be properly funded and properly staffed with appropriate status and skills, but I am very pleased that the emphasis in this debate has been on unpaid carers.

The report sets out excellent proposals and I am sure we have all been sent additional proposals from Carers UK, with an emphasis on issues such as an improved carer’s allowance related directly to the national living wage and—an issue that is extremely important to those concerned directly—some form of carer’s leave.

I want, however, to add an extra point about carers and their pensions. This arises because the unpaid carers are all too often, all too frequently, poor. They are poor because they are unable to work, or have to work limited hours, because of the care they are providing. It affects them directly during the period when they are providing care, but it also lingers on throughout their lives because they have missed opportunities for promotion and career development. The inevitable result is that they end up poor. The problem with their pensions is that, in our current pension system, you get a reasonable pension only if you have had a reasonable income while at work; because of the gap in your employment income, you have a gap in your pension.

There must be some way of improving the pensions provided for carers who have no, or limited, employment income. In one way or another, this will require providing them with credits for additional pension. My favoured approach is that they should get additional national insurance pension on top of their basic pension to make up for the gap arising from their inability to earn while providing care; so, these carers should get some additional credits for their state pension.

This is very much an issue for all carers—male, female, sons, daughters, parents. They are all affected in the same way but, as most care is provided by women, it impacts far more significantly on women. Hence, the main reason for the gender pensions gap, which should get more attention, is that women provide the care. The way to solve that problem is to provide them with some pension entitlements for the period when they were providing that care.

It is not mentioned in the report but I will now be pressing this issue as often as I can. Clearly, it is relevant here: care for carers means providing them with decent pensions.

NHS Procurement: Palantir Contract

Lord Davies of Brixton Excerpts

Thursday 22nd June 2023 Lords Chamber

[Lord Markham (Con)]

Yes. I really appreciate having this opportunity to state categorically that the NHS will remain the data user here. The data controller will remain in place for each individual institution; sometimes it is the GP and sometimes it is the hospital. Fundamentally, everyone’s data will be allowed to be used only by the NHS in these circumstances. There are no circumstances in which Palantir—or any other supplier should it win—will have access to see individuals’ data.

[Lord Davies of Brixton (Lab)]

My Lords, health service data is incredibly valuable. The Minister should, and probably does, understand the sensitivity of Palantir in this context. The Minister said that the quality of the contract was the only criterion. Where does price come into it? How can we build in protections against predatory pricing by the sitting tenants of contracts, who create an effective monopoly?

[Lord Markham (Con)]

I think I said that we wanted the best supplier to win; I will check and correct the record if I mentioned quality only. Quality is very important because the contract has to be good, of course, but the price has to be right as well. There are a number of criteria. Again, we will hold a session so will be able to take noble Lords through the whole process. I am confident that, at the end of that process, people will feel confident that we have reached a decision on the best supplier across all the criteria.

--- Later in debate ---

[Lord Markham (Con)]

Round about autumn time. Currently, we think that the contract will be awarded in September and then finalised. The new database should in place by April. Having this transition arrangement until June gives us a safety net to make sure that everything is in place.

[Lord Davies of Brixton (Lab)]

My Lords, I welcome the opportunity of a meeting to discuss data security. Can the Minister say whether it is anticipated that that security will go beyond what is currently being established in legislation going through Parliament? If it will be stronger, why are the other protections not stronger?

[Lord Markham (Con)]

I am sorry; I am not sure that I completely followed the question. It is fundamental here that everyone’s data is strongly protected in the best possible terms. As I say, we will arrange in the next few weeks a meeting where we can answer all the questions that noble Lords have and have the experts in the room as well.

Hospitals: Maintenance

Lord Davies of Brixton Excerpts

Thursday 9th February 2023 Lords Chamber

[Lord Markham (Con)]

Clearly, we want to give each trust the freedom to spend where it needs to. Obviously, there are overall Treasury rules but the main thing is the increased allocation we have made available in this space. We have spent £1.4 billion in the past year, which is a 57% increase, recognising that it is a good thing to put preventive maintenance in place to get on top of the backlog.

[Lord Davies of Brixton (Lab)]

My Lords, I may not be doing the Minister much justice but I admire his ability to give straight answers. I also admire his ability to maintain the fiction of 40 new hospitals. Does he accept that the Nuffield Trust puts the number of hospitals that any person in the street would recognise as new at three?

[Lord Markham (Con)]

I know that it is a lot more than that. The number of cohort 1 and cohort 2 hospitals being built at the moment is substantially more. This is a real programme; in fact, I invite all my colleagues here to a parliamentary open day, which I think will happen in the next month or so, when we plan to exhibit exactly what we are doing. We will have virtual reality glasses so that noble Lords can see the hospital of the future. Please come along and see for yourselves how real this programme is.

National Health Service Pension Schemes (Member Contributions etc.) (Amendment) (No. 3) Regulations 2022

Lord Davies of Brixton Excerpts

Wednesday 11th January 2023 Lords Chamber

Moved by

[Lord Davies of Brixton]

That this House regrets that the measures proposed by His Majesty’s Government in the National Health Service Pension Schemes (Member Contributions etc.) (Amendment) (No. 3) Regulations 2022 (SI 2022/ 1028) are insufficient to address fully the problems with staff retention in the NHS arising from the NHS pension arrangements.

Relevant document: 15th Report from the Secondary Legislation Scrutiny Committee

[Lord Davies of Brixton (Lab)]

My Lords, to a certain extent the burden of this Motion is uncontestable; the Government themselves accept that the measures proposed are insufficient because they have put down some further changes that will come before us in due course. I look forward to a further debate. This is an important issue, and I welcome the opportunity for a discussion.

Yesterday, on the winter crisis Statement, the Minister said that

“we should be learning all lessons. I like to think that, three months into my role, I am learning some of those lessons.”—[Official Report, 10/1/23; col. 1316.]

I am pleased to provide the opportunity for the Minister to learn more about the impact that the pension tax rules—the lifetime allowance and the annual allowance—are having on the work that he is undertaking to get our NHS back into shape. I did not seek to intervene yesterday when the Minister made the Statement, as I knew we had today’s debate. Of course, the crisis is not the product of short-term problems but the result of 12 years of political choices—but we are not going to debate that again.

The taxation issues, however, are still highly relevant. It is no good promising extra beds and shorter waiting times if you do not have the staff to provide the care, and there is no doubt that the rules are having an adverse effect on staff retention at senior levels, as well as—possibly even more important—on the morale of the staff whom we depend on. We are all agreed: for example, the last Prime Minister promised to

“stem the exodus of doctors from the NHS”,

and the Prime Minister before that promised to fix the pension tax relief rules. The current Chancellor, albeit before he took up that role, called the situation a national scandal. He also tweeted on 4 August that, among the actions needed to get the NHS back on its feet, the Government should:

“Grant an immediate exemption for doctors to public sector pension rules which are currently forcing them to retire in their fifties in alarming numbers”.


Even the current Health and Social Care Secretary, Steve Barclay MP, has said that the NHS Pension Scheme

“is one of the best in the country, but it’s not working as it should for everyone”,

so I am pleased that the Minister is here and ready to learn lessons. The problem, as he might be the first to acknowledge, is that the real solutions are not in his hands or those of his department. The solutions lie in the hands of the Treasury, which sets the pension tax rules and effectively controls the rules of public service pension schemes. Of course, this is a general problem which I could speak at great length about, but given the crisis we face in the NHS it is right that in this debate we should focus on what can be done in this area for the NHS.

As I have said, my Motion is indisputable. These provisions were inadequate and we have further changes, which are currently the subject of discussion. The Secretary of State has said:

“We need a system where our most experienced clinicians don’t feel they have to reduce their workload or take early retirement because of financial worries”.


This suggests that he understands the problem but, unfortunately, the further proposals currently out for consultation tell us that he does not, and that what has been proposed so far is insufficient. This is where it starts to get technical and the current forum, where slides and spreadsheet presentations are out of order, is not really conducive to a full explanation. Possibly it might be useful to have a meeting, but let us have a go at outlining the issues.

There are a number of problems, not least the lifetime allowance, but I want to focus in this debate on two issues that arise from the annual allowance: the limit on how much extra pension National Health Service employees can accrue each year, tax free. If you exceed the limit, there is a penal tax rate involved on the portion of growth of a member’s pension rights in excess of a defined amount, currently £40,000. It is a penal rate because tax is levied on the money as it goes into the scheme and then again when it is paid out as benefits. Effectively, that is a tax rate on pensions savings of up to 70%. While I am not against high earners paying more in income tax, it still needs to be applied equitably and fairly, and certainly not when people are doing the right thing by providing themselves with an adequate pension.

The growth in pension savings during a tax year, which is limited by the annual allowance, is referred to as the pension input amount. This is the increase in the value of the individual’s pension rights, starting from an opening value immediately before the beginning of the tax year and going to the closing value at its end. It consists of two parts: the increase in the pension that they had previously accrued and the additional pension that they earned during the current year. If, after allowing for inflation, an individual’s pension input amount is more than the annual allowance of £40,000, the individual is liable to pay tax on the excess, so the clear intention is that the pension input amount should consider only growth in pension savings above inflation. There are two major problems with how this works in practice. First, there is an index mismatch; secondly, there is the problem of negative pensions growth.

--- Later in debate ---

[Lord Davies of Brixton (Lab)]

My Lords, I thank the Minister for his response. I am sure everyone will be relieved that I am not going to push the Motion to a vote and say that my main intention this evening was to ensure that we took this opportunity for the relevant department and the Minister to understand the issues involved. The solution has to be one which is acceptable to the doctors. It goes without saying, really, that we can discuss this as much as we like, but it is the doctors who have to say, ultimately, “Yes, this solves the problem; we are not being forced to retire.” In that light, I beg leave to withdraw.

Motion withdrawn.