Mental Health Bill [HL]

Lord Kamall Excerpts

Report stage
Monday 31st March 2025 Lords Chamber

[Lord Scriven (LD)]

My Lords, I rise to speak to a number of amendments that I have added my name to, particularly those in the name of the noble Baroness, Lady Hollins. In Committee, the whole issue of people with learning disabilities and autism caused a number of concerns. I note that the Minister has gone some way towards dealing with some of those concerns, and it is a tribute to her listening and enaction skills that progress has been made.

I think it would be fair to say that there are still some concerns on Benches across the House about potential unintended consequences for people with learning disabilities and autism if the Bill goes through in its present form. In some areas, I would describe the statement from the Minister as, “It’ll be all right on the night”—but we know that, sometimes, it is not all right on the night, and things will happen.

The noble Baroness, Lady Hollins, puts forward quite an important base for long-term segregation. There is no evidence that it has a long-term therapeutic benefit for people who have learning disabilities and autism, and so the provision for it still being there, without laser-focused monitoring and intervention, is a weakness. The Minister really has to convince the House that the Government have a plan to deal with this.

The worry about having too much faith in the code of practice, as we found out in Committee, is that simple words such as “should” and “must” have very different meanings for whether or not there is a statutory obligation on an organisation. It would be interesting to hear the Minister’s view on the focus in the code of practice and on strengthening the words used.

Amendment 4, to which I have added my name, is something that the House should focus on and understand. Throughout the history of implementation of improvements in mental health and other areas where community carers come in, they have always fallen down on implementation, due to a lack of either funding or resources. Amendment 4 focuses on implementation. As the noble Lord, Lord Crisp, has just said, in the Autism Act 2009 Committee, we heard from two witnesses who said there is a plethora of policy but it is always the plan on implementation that fails. The amendment in the name of the noble Baroness, Lady Hollins, focuses on that implementation and asks that the Government have a real plan to do that.

It was worrying as we went through Committee, particularly when issues were raised about the numbers in the impact assessment, that the Minister pointed out that they are indicative. The amendment in the name of the noble Baroness, Lady Hollins, is required because, if we take a look at the trend of the percentage of total healthcare spend that has been allocated to mental health, including the Government’s announcement last week, we find that there have now been two years in which the total spend will be reduced. That means that some of the good ideas that the Government have mentioned with regard to the implementation of this Bill and community services are potentially at risk.

I do not know whether the noble Baroness will press her amendment, but, if she does, she will have the support of these Benches. We think this is vital, and we are not quite convinced, unless the Minister says something to that effect from the Dispatch Box, that that crack—that real weakness—has been dealt with.

[Lord Kamall (Con)]

My Lords, before I begin my remarks, I express my gratitude to the Minister and to officials for their engagement with not only me but other noble Lords between Committee and now. I know I am not alone in appreciating the amount of time and work that the Minister and officials have put into meeting with us, addressing our concerns, and even having follow-up meetings; that was very much appreciated.

I will speak to Amendment 1, in the name of my noble friend Lady Browning, and briefly address some of the other amendments in this group. We supported my noble friend Lady Browning’s intention to retable this amendment, which seeks to address the loophole which could lead to the use of the Mental Capacity Act to detain patients with learning disabilities but without a recurring condition.

As noble Lords have acknowledged, both in Committee and today, once the legal basis for detention under the Mental Health Act is removed for these patients, there was always a profound risk of them falling under the deprivation of liberty safeguards. Nobody wishes to see extra safeguards introduced into the Mental Health Act for that to be simply replaced with detention by another Act. My noble friend said today that she has received further assurances from the Minister—we are grateful for those assurances—and that she is no longer minded to test the opinion of the House. Had she been minded to test the opinion of the House, she would have had our full support, but I am grateful for the assurances that the Minister has given to my noble friend.

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Moved by

[Lord Kamall]

7: Clause 5, page 11, line 22, after “detained” insert “by a constable or other authorised person”
Member’s explanatory statement
This amendment and others in the name of Lord Kamall seek to introduce a new category of “authorised person” who can carry out detentions under the 1983 Act to offer better inter-agency response. The proposed amendments would remove the need for the presence of police at mental health incidents in the absence of any risk.

[Lord Kamall (Con)]

My Lords, these amendments in my name and that of my noble friend Lord Howe are really amendments from my noble friend Lady May, who unfortunately cannot be in her place today. As my noble friend told the House in Committee, when she was Home Secretary, a recurring concern raised by police officers was being called out to situations where they were expected to determine whether someone was at the point of crisis and what should happen to that individual. As we know, that usually meant taking the individual to a police cell as a place of safety—an issue that is addressed in other parts of the Bill. But police officers continue to be concerned that they are asked to deal with something for which they have no, or insufficient, training or knowledge.

As my noble friend reminded the House, a police presence is also often not good for the individual, as not only is that individual not being given the healthcare support they need, but the presence of an officer in uniform coming to deal with them could exacerbate their mental health situation. Even if the police officer is able to get somebody to a hospital, they might still be required to sit with an individual to make sure they do not harm themselves or others. My noble friend Lady May cited the Metropolitan Police’s evidence to the Joint Committee on the draft Bill, where it gave an example of a patient in A&E who was required to be guarded by eight Metropolitan Police officers over 29 hours to prevent them being a high-risk missing person.

In its letter to the current Secretary of State, the National Police Chiefs’ Council was concerned that the law as it currently stands

“arguably views mental health through the lens of crime and policing related risk, which raises … issues including disproportionality in the criminal justice system, discrimination, adverse outcomes for people suffering with poor mental health as well as increasing stigma attached to mental health”.

I make it clear that, although this amendment removes the statutory demand for the police to be the primary responders to incidents of mental health where there is an immediate risk to life or serious injury, the police will still have a role to play.

The amendments specify that the authorised person attending an individual should be

“trained and equipped to carry out detentions”

and should not be

“put at unnecessary risk by carrying out those functions”.

This is in line with the College of Policing’s 2019 mental health snapshot, which found that almost 95% of calls that police attend that are flagged as a mental health response do not require a police response.

The Minister will be aware that, in the joint Home Office and Department of Health review and survey of Sections 135 and 136 powers, 68% of respondents agreed that all or part of Sections 135 and 136 powers should be extended so that healthcare professionals could use them, provided that they were not putting themselves at risk. Paramedics in particular supported a change, with more than 90% agreeing and more than 60% strongly agreeing.

However, this is not just about the interests of the police and healthcare professionals. More importantly, we need to focus on the individual at the point of mental health crisis. They deserve the right response, the right care and the right person.

I note that the Minister, in our conversations—I appreciate her giving forewarning of this—discussed how the amendment as it stands appears to give the police more powers. I discussed that with my noble friend Lady May before I came to the Chamber, and she was surprised at this and said that it was somewhat disappointing, given the constructive meetings that the Minister and my noble friend have had, and given that the Metropolitan Police said that they were supportive of this move when my noble friend met representatives last year.

There is clearly a difference of opinion here, and we appreciate that we need to find a way forward. I know that my noble friend Lady May is open to discussions with the Minister to ensure that the principle behind these amendments is met. Could the Minister give a guarantee to meet my noble friend and that, following these discussions back and forth, she will be able to bring back an amendment at Third Reading?

The fundamental principle remains unchanged: the role of police in detentions under the Mental Health Act must be reduced, and it must be reduced for the patients’ and the workers’ benefit. If the Government can accept the principle but not necessarily the precise wording, I hope that the Minister will be able to give the assurances that I and my noble friend Lady May have asked for. I am afraid that, if the Minister cannot give the assurance that she can bring forward an amendment at Third Reading, having had discussions with my noble friend Lady May, we will have to test the opinion of the House. I hope that the Minister can help to find a constructive way forward with my noble friend.

[Lord Davies of Brixton (Lab)]

I am extremely pleased that the noble Lord, Lord Kamall, has moved his amendment for the Opposition. I will not be voting for it, but I am pleased that it has been moved because in Committee I moved amendments along the same lines.

I know that my noble friend the Minister agrees with the suggestion that there is a challenge here for the Government—she told me so. This issue is not going to go away, and it would be a constructive way forward for there to be a meeting—I would ask to be included in any such meeting. We are clear about where we want to get to, and that the appropriate phrase is “right care, right person”. I do not think that that is currently being delivered, so something needs to be done. I hope that we can move to a better system, in a constructive way.

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[Lord Kamall (Con)]

My Lords, I am grateful to the Minister for addressing the points that were raised, and I listened carefully to what she said. I had hoped that she would be open to resolving this issue, as I know she is with my noble friend Lady May. However, once again, there is a difference of opinion. As I understand it, amendments brought forward at Third Reading do not have to be only technical amendments and I had hoped that the Minister would give an undertaking to bring back an amendment at that stage. Given that we have a disagreement of interpretation on two issues, I am afraid I think it best to test the opinion—

[Baroness Merron (Lab)]

It might be helpful for your Lordships’ House to know that to fulfil what the noble Lord says, there would be a need for collective agreement to offer a commitment to bring forward an amendment at Third Reading, which I do not have. I emphasise the point made by my noble friend on this.

[Lord Kamall (Con)]

That is entirely understandable. I know the Minister always means well in our discussions and always tries to find a solution, but, given that, it may be helpful to finding a solution if I test the opinion of the House.

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Moved by

[Lord Kamall]

8: Clause 5, page 11, line 33, after “detained” insert “by a constable or other authorised person”
Member’s explanatory statement
This amendment and others in the name of Lord Kamall seek to introduce a new category of “authorised person” who can carry out detentions under the 1983 Act to offer better inter-agency response. The proposed amendments would remove the need for the presence of police at mental health incidents in the absence of any risk.

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[Baroness Tyler of Enfield (LD)]

My Lords, I will very briefly speak in support of this very important set of amendments. As my noble friend Lord Scriven set out on Amendment 11, which I very strongly support, the case for having some conditionality around community treatment orders is overwhelming, including making them time limited and having a second doctor’s certification to confirm their therapeutic benefit. Both are very hard to argue against. They get the right balance between, as we heard in earlier stages, those who want to get rid of the orders altogether and those who feel that we need to tighten up the conditions. The other two review amendments are also very important.

Finally, we need to remind ourselves, as we did at Second Reading and in Committee, that black people are seven times more likely to be on a community treatment order than other members of the population. That is why this is so important.

[Lord Kamall (Con)]

My Lords, I thank the noble Lord, Lord Scriven, for the excellent way he introduced his Amendment 11. I fully support everything that he said.

The suitability of community treatment orders is an issue that has obviously featured heavily in the discussions on the Bill so far. I think that many of us came to the debates on the Bill, having read the Joint Committee’s pre-legislative scrutiny report, thinking that we were going to support the abolition of community treatment orders or be very sympathetic to that idea. However, two contributions gave us a reason to pause and think. One was the personal story from the noble Baroness, Lady Parminter; the other was hearing the noble Baroness, Lady Barker, say that she previously believed that they should be abolished before realising that they are entirely appropriate for a small number of situations or cases. In fact, given that one of the principles of the Bill is imposing the least amount of restriction, maybe they are the least restrictive solution for some incidents.

Having said that, very serious concerns obviously remain about the use of community treatment orders in their current form. Other noble Lords and I spoke in Committee about the overrepresentation of black males, which is what my Amendment 62 intends to address. It was a shame that the deliberations on this issue came so late at night, but I thank the Minister and her officials for their engagement. I asked three simple questions: what do we know about why black people are disproportionately detained? What do we not know? What research and work are we conducting—I know this sounds like a PhD research thesis seeking to generate the research questions so that someone can go from an MPhil to their PhD—and what is the gap in research to generate the questions for the primary research?

I was very reassured by the responses from the Minister and her officials that they take this seriously. They set out in detail the work that they are doing. In fact, the Minister put a lot of that in a letter to me. It would be unfair of me to ask her to read out precisely what is in that letter, because we would be here for quite a few hours, but can she share some of those assurances with the House? It would be very helpful for other noble Lords to understand why, given that letter, I have decided that I will not push my amendment to a vote.

As I said, the noble Lord, Lord Scriven, has struck the right balance. The amendment acknowledges that there are issues with CTOs and allows for their continued use, under restrictions. It is really important that, in every case, there is a review, and 12 months would seem an appropriate time for that review, rather than cases just being forgotten about, people being caught up in other casework or cases falling behind the filing cabinet—if there was another analogy I could use, I would. If the noble Lord, Lord Scriven, decides to divide the House, these Benches will support him.

I look forward to hearing some of the assurances the Minister gave to me and others on racial disparities. I hope also that she can address the concerns of the noble Lord, Lord Scriven.

Mental Health Bill [HL]

Lord Kamall Excerpts

Report stage
Monday 31st March 2025 Lords Chamber

[Lord Davies of Brixton (Lab)]

I want to express my support for the amendment from my noble friend Lord Bradley, because in Committee I had a parallel amendment that dealt with a similar issue. I very much agree with what the noble Baroness, Lady Tyler of Enfield, said about locating specific responsibility for getting people through the system. In this area, time is absolutely of the essence to avoid crises and worsening mental health states. So I strongly support the thought behind my noble friend’s amendment, and I hope the Minister can help us by showing that the problem is understood and that the Government see it as a priority to resolve the problems that undoubtedly occur at present.

[Lord Kamall (Con)]

My Lords, I will speak briefly to Amendments 38 and 40. One of the things about being a politician is that when you say things, you cannot hide. When the noble Lord, Lord Bradley, told me he was about to quote me in his contribution, I thought, “Oh no, what have I said now?”, so I am grateful to him for warning me and not being too harsh on me. As other noble Lords have said, this is an eminently sensible amendment, and I hope we will get a positive response from the Minister.

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Moved by

[Lord Kamall]

44: After Clause 47, insert the following new Clause—
“Removal of patients by authorised persons (1) The Mental Health Act 1983 is amended as follows.(2) In section 135 (warrant to search for and remove patients)—(a) in subsection (1), after “constable”, insert “or authorised person”;(b) in subsection (1A), after “constable”, insert “or authorised person”;(c) in closing words of subsection (2), after “constable”, insert “or authorised person”;(d) in subsection (3ZA)(a)(ii), after “constable”, insert “or authorised person”;(e) in subsection (7)(b), after “constable”, insert “or authorised person”. (3) In section 136 (removal etc of mentally disordered persons without a warrant)—(a) in subsection (1), after each instance of “constable”, insert “or authorised person”;(b) in subsection (1A), after “constable”, insert “or authorised person”;(c) in subsection (1B), after “constable”, insert “or authorised person”;(d) in subsection (2A)(a)(ii), after “constable”, insert “or authorised person”.”Member's explanatory statement
This amendment and others in the name of Lord Kamall seek to introduce a new category of “authorised person” who can carry out detentions under the 1983 Act to offer better inter-agency response. The proposed amendments would remove the need for the presence of police at mental health incidents in the absence of any risk.

Pharmacy Opening Hours

Lord Kamall Excerpts

Thursday 20th March 2025 Lords Chamber

[Baroness Merron (Lab)]

I know the noble Lord talked about primary care more generally, but the assessment on pharmacies is that there is quite a good coverage. Some 80% of the population live within a mile of a pharmacy and, as I say, there are other online and not-in-person ways of contacting pharmacies. The Pharmacy Access Scheme provides financial support to pharmacies in areas where there are fewer pharmacies. Local authorities, along with ICBs, continue to monitor changes, look at provision and have the ability to intervene where necessary. On all these counts, in respect of primary care provided through pharmacy, which is so important, we continue to monitor the impact across ICBs. With regard to a particular assessment, I will gladly write with more details to the noble Lord.

[Lord Kamall (Con)]

My Lords, the Minister has rightly talked about some of the alternatives, particularly when hours are limited. Can I ask her about some of the long-term thinking in the department on the future of pharmacy services? We know that some chains, for example, have in-store pharmacies. What thought has been given to more of these partnerships—and also, perhaps, pharmacies as part of future primary healthcare centres? While many people may want a bricks and mortar pharmacy, those who use the NHS app, for example, may be happy to order repeat prescriptions and have them delivered or pick them up from a local location.

Patients are also more open to ideas of online consultation. We have seen Royal Mail trialling delivery by drones in remote areas. There is a whole host of things happening in other sectors that the pharmacy sector and other parts of our health and care sector can learn from. What is the department learning from this innovation in other parts of the economy?

[Baroness Merron (Lab)]

The noble Lord makes some very constructive points and illustrates further the point that there are many ways to deliver pharmaceutical services. I can assure him that we are exploring how pharmacy can best be positioned—and indeed levered—to fit our ambition for a neighbourhood health service within the NHS 10-year plan. More will be heard about that soon.

The noble Lord will also be aware that one of the challenges that community pharmacies raised with us is about funding, which was cut or held flat between 2015-16 and 2023-24, representing a cut of some 28%. That is why we have concluded the consultation about funding; we will shortly announce the outcome, looking at how these private businesses can operate in the market. We are keen to ensure that they play their part and continue to work very constructively with them.

Covid-19: Day of Reflection

Lord Kamall Excerpts

Thursday 20th March 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, I thank the right reverend Prelate the Bishop of London for securing this debate on this important matter. I thank her and the noble Baroness, Lady Brinton, for their moving remarks about the lessons they feel we ought to learn.

Listening to the moving opening remarks from the right reverend Prelate, I was reminded that we all have experience of losing people during Covid and of grief, or perhaps delayed grief. I will share my own experience, if I may, not for therapy but for reflection. On 20 September 2020, I lost my father-in-law and then, four hours later, I lost my father; my children lost both their grandfathers on the same night. Both of them lived abroad, and so we were not able to grieve in the usual way. We had to watch the funerals, one day after the other, on a WhatsApp video. It was not until July 2022 that I was able to visit my father’s grave in America and break down and cry, and to scatter the ashes of my father-in-law in another country. You realise when you break down and cry the feelings that you had been holding back all these years, and how that has been debilitating in some ways. I had not realised that until that time.

Given that, I want to take the opportunity to express my condolences and sympathy to all those who suffered personally or lost loved ones during the pandemic. I pay tribute to all the wonderful health and care workers who looked after us and those suffering from Covid-19. We should acknowledge the work of public and private sector workers who carried on working to deliver essential services—some of which are not always considered essential services, whether it be driving buses or home delivery. While others were able to isolate quite safely in their own homes, they put themselves at risk.

Noble Lords will be aware that, when in Government, we announced the NHS and social care coronavirus life assurance scheme to protect the families of front-line NHS and social care workers who sadly died while providing essential work. Initially, it was a payment of £60,000 to the families in England, with funding for similar schemes in Scotland, Wales and Northern Ireland, but we felt it was important to increase that level of support to families facing bereavement. Sadly, uptake was not as high as it could have been, and we had to extend the scheme to September 2023 to ensure that more families could benefit.

While money can help in many cases, other types of support are, as the right reverend Prelate and the noble Baroness discussed, important for bereaved people. In 2021, research indicated that, for every Covid-19 death, there were up to nine people affected by bereavement, highlighting the importance of bereavement care. There are those who are still experiencing ongoing bereavement. As I say, it took me two years, and there are others who still have not found closure in their own lives on these issues. It is really important that they continue to receive the necessary support and care.

The world-renowned Mayo Clinic has defined “ongoing bereavement” as when

“feelings of loss are debilitating and don’t improve even after time passes”.

We are often told that time heals all wounds; in many cases, those wounds still have not healed for people. Many of us have lost loved ones or friends, but those with ongoing bereavement find it incredibly difficult and challenging to get on with their daily lives and to do even the simplest things.

Noble Lords may be aware that the very first recommendation of the UK Commission on Covid Commemoration was the introduction of a UK-wide day of reflection, to be held on the first Sunday of March, to commemorate the anniversary of the first lockdown. The report says—I think it is worth repeating—that this is to

“remember and commemorate those who lost their lives since the pandemic began … reflect on the sacrifices made by many, and on the impact of the pandemic on us all … pay tribute to the work of health and social care staff, frontline workers and researchers … appreciate those who volunteered and showed acts of kindness during this unprecedented time”.

I know that in all our faiths there are always references to small acts of kindness, and we saw some amazing acts of kindness throughout, even though it was a horrible time and a time of great grief and uncertainty for many people. We welcome the Government’s decision to continue the commitment of the last Government to commemorate this anniversary. It is important to remember all those who were lost, and the Government should be credited with continuing to recognise this.

One topic I would like to ask the Minister about is bereavement education, which was raised by both the right reverend Prelate and the noble Baroness. As others have said, in many cultures, death may be celebrated or simply accepted as part of the circle of life, with young children attending funerals or ceremonies to understand the inevitability of death. In our culture, we are not so open about these issues. We often do not deal with death until a friend or loved one passes away, especially when it is unexpected.

I sometimes think about the New Orleans funerals: they start off in a very sombre mood, with marching, but then suddenly the mood changes to one of a celebration of a life. I have often said to my wife—I do not envy her, if she survives me—that I want a combination of a Muslim funeral and a New Orleans funeral. I am not sure how that would go down, or whether the imam would appreciate the switch-over. We should celebrate life, and make sure that we remember to discuss death earlier in our lives.

I was a bit worried about making people laugh, because, until now, it felt as though we were at a funeral, but I am very pleased that we can have a laugh. Sometimes people laugh when they celebrate a life; they tell stories and have fond memories of the person who has passed away. That is a wonderful way of making sure that we celebrate people. As the noble Baroness, Lady Brinton, said, faith leaders—indeed, the right reverend Prelate is one herself—are very good at helping families to face grief and bereavement.

What more can be done? On the review of the relationship, sex and health education—RSHE—statutory guidance, can the Minister update the House on whether some thought is being given to include specific content on grief and bereavement education? If not, can she share any current thinking on the options being considered? Both the right reverend Prelate and the noble Baroness discussed the importance of this. Sometimes, it is not very easy to do that in a top-down, government-led way, so how do we create a space to ensure that we talk about these issues? I know it is not an easy subject to tackle, and it needs to be treated with the utmost sensitivity. Anything that the Minister can share with us today, or in writing later, would be gratefully received.

Finally, given the importance of the issues that we have discussed in this debate, can the Minister give the House a firm date for when a response to the UK Commission on Covid Commemoration’s final report will be published?

The subjects we are discussing are part of an understandably complex and sensitive area. We were all touched by Covid, either directly or indirectly. We all lost loved ones or friends, or we heard stories from those who did, and some of us suffered from delayed or extended bereavements. The best thing we can take from the debate is this: let us not forget those who passed away; let us not forget those who are still suffering from the effects of long Covid; and let us not forget those who are still experiencing bereavement.

NHS Dentistry

Lord Kamall Excerpts

Wednesday 19th March 2025 Lords Chamber

[Baroness Merron (Lab)]

There is a cavity that needs filling. I defer to the usual channels, the senior leadership, the leaders of all parties, the Convenor of the Cross Benches, and all the other bodies that decide who should be in this House.

[Lord Kamall (Con)]

My Lords, I say to the noble Baroness that when it comes to comedy, she is doing an excellent job as a Minister.

[Noble Lords]

Oh!

[Lord Kamall (Con)]

I am sorry—I hope she takes that in the way it was intended. She is a wonderful comedian and a wonderful Minister. How about that? Hopefully, I have redeemed myself in the eyes of the Minister.

One of the frustrations of the past on this issue has been the battle between the Treasury and the department over the unit of dental activity—the UDA—as the noble Lord, Lord Rennard, said. That is how much dentists are paid for each patient they see. Can the Minister tell your Lordships about the conversations that her department is having with the Treasury? For example, how willing is it to raise the UDA in dental deserts to encourage local dentists who exist in those areas but do not see NHS patients? What conversations is the department having also with dental charities in the shorter term to help fill some of these gaps?

Safe Housing and Hospital Discharge

Lord Kamall Excerpts

Wednesday 19th March 2025 Lords Chamber

[Baroness Merron (Lab)]

My noble friend has given me an invitation to agree with him. As he knows, it would be quite inappropriate to suggest that integrated care boards are not integrated or about care—that is their focus—but I appreciate his view on the matter. I do agree with him that much good work is done on the health and well-being boards. This all says to me that local decision-making, and local provision for local populations with their particular dimensions and demands, is the best way forward. My final point on this question is that local systems have to agree plans to achieve more timely and effective discharge from hospital, and to work with local authorities to develop those plans.

[Lord Kamall (Con)]

My Lords, NHS data from last month revealed that there are about 13,800 people who are medically fit for discharge, which is up from 12,000 patients awaiting discharge on 1 December. As other noble Lords have said, we know that that causes a bottleneck in hospitals that is not good for patients while they wait to go home. As has been said, one way to reduce that bottleneck is the greater use of virtual wards, allowing people to stay in their home for longer, to be monitored in their home and to receive care. The Minister has answered this question to a certain extent, but can she tell us more about the Government’s overall plan for virtual wards, not just in this case but for physical and mental health care, in order to ensure that we can get more patients out of hospital beds and into their homes, where they can receive the care they deserve and be constantly monitored?

[Baroness Merron (Lab)]

I am glad that the noble Lord shares my enthusiasm for virtual wards. I shall expand on what they are: they allow people to be not in hospital but in their own home, whether it is their personal home or whether their home happens to be in a care home or some other setting, by the use of technology that allows them to be monitored. I recently saw an excellent example of that, and the liberation that it provides for individuals who would much rather not be in hospital is key. The noble Lord will know that, in the 10-year plan, the move from hospital to community is a key pillar, and we will soon be reporting on that. I certainly share his enthusiasm.

NHS England Update

Lord Kamall Excerpts

Wednesday 19th March 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, no one can really disagree with the intention to reduce unnecessary duplication between the NHS and the Department of Health and Social Care, so these Benches welcome these proposals where they ensure value for money for taxpayers and free up money from bureaucracy to spend on front-line services. One of the many things that many medical staff have complained about is the amount of paperwork. We hope that these reforms and better investment in technology will reduce the time spent on administration. Although administration can be tedious, it provides much-needed data to monitor the level of services and, we hope, to improve patient care. But these changes need to be judged on more than just money; they must make sure that the patient remains at the centre of the conversation when we talk about our system of health and care.

We have had many reforms over the years, and whether these reforms are the right ones can be judged only on what comes next. My noble friend Lord Lansley, who has been much maligned recently, has written that the lesson he learned from the 2012 reforms is that his Government, and subsequent Governments, delivered only one part of the intended reforms—creating NHS England—but did not always intervene when NHS England sought to block other reforms, such as clinically led local commissioning, competition and choice, choice of large-scale commissioning support organisations, tariff reform, “any qualified provider”, and an annual mandate from the Government and Parliament to the NHS, with accountability through the NHS outcomes framework. This, he believes, is what led to the centralised, bureaucratic system that the Government are trying to reform.

Whether noble Lords agree with my noble friend or not, surely the lesson is to have an overall plan for reform and to intervene when a bureaucracy is a barrier to further reform. For this reason, noble Lords look forward to the publication of the 10-year plan. I wonder, at this stage, whether I can tempt the Minister to say whether she is any closer to giving us a date for that 10-year plan. I suspect that these reforms have to be seen in conjunction with the 10-year plan, and cannot be seen in isolation.

Given these lessons, where clinical leaders are calling for greater autonomy from centralised control in order to offer better care for patients at a local level, how do the Government intend to balance centralisation to the DHSC with empowering clinicians and giving them autonomy at a local level? They are better equipped to know what services are needed locally.

I know from my experience of organisational change that it is often not enough to change structures if the organisational culture does not also change. I will give your Lordships an example. I had an operation in Brussels a few years ago, and when I came back to the UK I wanted to have my annual check-up. I contacted a GP and eventually got a double appointment: an ECG at a local health centre, and a consultant phone call a week later. I thought that this was really good and modern. The ECG went smoothly and, a week later, I got a phone call from a junior doctor in the consultant’s office. It was clear that he had not seen the ECG, so I asked him, “Have you seen the ECG?” He said, “No”. I asked, “Can I tell you exactly what time, what day, and where it was, then you can call me back and we can discuss it?” He refused, and said, “I’ll just make a new appointment, including a new ECG”. I wonder what it is in the system that incentivises this sort of behaviour, rather than making that phone call and saving taxpayers an awful lot of money.

Although these changes will save money, which is welcome, can the Minister provide clarity to the House on how these reforms will drive efficiency and cultural change within the health service, and ensure that we improve care, with patients at the centre?

One of the key challenges your Lordships will be aware of when dealing with the NHS is the lack of willingness to own mistakes and accept responsibility. The NHS needs to be better at taking responsibility when targets are missed and things go wrong. Can the Minister assure your Lordships that the new structure the Government propose will have clear lines of responsibility, redress and transparency? Will it allow noble Lords, other politicians and people throughout the country to understand how the NHS is governed, who is responsible for what and how it operates? I look forward to hearing from the Minister, and I hope that we can work constructively, on a cross-party basis, to improve patient outcomes and our system of health and care.

[Lord Scriven (LD)]

My Lords, the Government, with their sovereign right, propose the abolition of NHS England. Although the method of delivery is a matter for the Secretary of State to propose, governance changes in themselves will not achieve better outcomes. These Benches will continue to point out that chronic operational issues in the NHS cannot and will not be dealt with effectively until the Government show the same speed and determination to deal with the social care crisis. The Minister must know that you cannot have 13,000 hospital beds full of people medically fit for discharge and pretend that a change of who sits in what chairs in the governance of the NHS will solve that issue. When will the Government commit to a timetable to restart the cross-party talks to deal with this important issue?

The paramount—indeed, the sole—objective of any organisational change to the NHS must be demonstrable improvement of patient experience and outcomes. The Government assert that this change will improve efficiency and streamline services. However, assertions alone are insufficient. We require rigorous evidence, not mere conjecture.

Therefore, I am going to ask the Minister five questions. First, and most importantly, what detailed analysis has been conducted on the projected impact of this abolition on patient outcomes? We require more than abstract pronouncements. For instance, how will it improve cancer treatment? What will these changes do to improve access to GP services? How will they improve local integration, particularly when 50% of funding for ICBs will be reduced across the board?

Secondly, what specific legislative changes are required to abolish NHS England and redistribute its functions? I note that the Secretary of State pointed out that the Government could predominantly go ahead with these changes but that legislation is required, so will the Minister explain to the House exactly what legislation will be required to bring about this change? Will she give a commitment that no redundancies will take place until legislation has been passed and these changes have been given the go-ahead by this House and the other House?

Talking of redundancies, my third question is: what are the estimated costs of redundancies associated with the abolition of NHS England, including not only financial implications but the potential loss of expertise and institutional knowledge? Furthermore, will the Minister indicate whether any departing executive has been offered a severance package exceeding statutory redundancy limits and, if so, how many? What justifications are there if such arrangements have been made?

Fourthly, how will the Government ensure continuity of service during the transition period? Any disruption to patient care is unacceptable, so when will there be a robust plan that outlines how essential services will be maintained, how staff will be supported and how the public will be kept informed?

Finally, in line with what the noble Lord, Lord Kamall, said, what mechanisms will be put in place to ensure ongoing accountability and transparency in the newly restructured healthcare system? How will the Government measure success—not just of the times in which people are seen but that these changes have contributed to improvements in patient care? The Government are the custodians of this vital public service and have a duty to ensure that any changes to NHS structures are driven by evidence, guided by principle and focused relentlessly on improving the lives of the people it serves. They must proceed not blindly but with clarity, so I look forward to the Minister’s answers.

Soft Drinks Industry Levy

Lord Kamall Excerpts

Tuesday 18th March 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, although sugar taxes and levies are examples of top-down state solutions to tackle obesity, I will ask the Minister about grass-roots, bottom-up solutions. She will know of non-state local civil society projects that work in communities to encourage healthier lifestyles, such as BRITE Box in south London, which offers recipes, ingredients and budgeting advice to help low-income families cook and eat more healthily. Can she tell your Lordships how the department works with such local projects to tackle obesity and how that best practice has spread to other communities? Could she also write to me with a list of some of the projects that her department is aware of, so that all noble Lords could learn a bit more?

[Baroness Merron (Lab)]

I would be very pleased to write further to the noble Lord on this matter. I pay tribute to all of those community third sector organisations that work in line with government direction to reduce obesity. There are many aspects to this: it is not just about what community organisations can do but, for example, about implementing TV and online advertising restrictions for less healthy food. In all these ways, we will be able to make progress to reduce obesity.

Primary Healthcare Facilities

Lord Kamall Excerpts

Monday 17th March 2025 Lords Chamber

[Baroness Merron (Lab)]

We will be providing further details in the national implementation programme, but I can say that neighbourhood health guidelines have already been published to help ICBs, local authorities and health and care providers to continue to progress neighbourhood health. We will trial neighbourhood health centres to bring together a range of services, and others that the noble Baroness refers to, to ensure that healthcare is closer to home and that patients receive the care they deserve when and how they need it.

[Lord Kamall (Con)]

My Lords, we know that the Government are keen to encourage more investment into our national infrastructure—which these Benches welcome. Given that, what conversations are the Department of Health and Social Care and the Treasury having with pension funds and other funds on investing in neighbourhood primary health and care facilities, and indeed in other parts of our system of health and social care?

[Baroness Merron (Lab)]

Although I cannot give a specific answer to the noble Lord on that point, I will be happy to look into it. As I mentioned earlier, in our discussions with the Ministry of Housing, Communities and Local Government we are, for example, looking at how we can lever greater contributions from developers who are working on new developments, where they will be providing much-needed health services and infrastructure. So we are taking a creative approach because we recognise the need to do more.

Apricity Fertility Closure

Lord Kamall Excerpts

Wednesday 12th March 2025 Lords Chamber

[Baroness Merron (Lab)]

I agree with the noble Baroness’s observations. The legislation goes back to 1990. We are in 2025, and there has been an advent of many new technologies, techniques and business models—for example, the noble Baroness, Lady Owen, referred to Apricity—that were never imagined just a few years ago, let alone in 1990.

The majority of clinics are privately owned. Many are part of large groups with external finance. Elements of fertility care and associated treatments are increasingly offered online or outside HFEA regulation. There is a huge challenge here. That is why we are in discussion with the HFEA, and we will be in discussion tomorrow.

[Lord Kamall (Con)]

My Lords, the Minister will recall that in 2022 the previous Government published the 10-year Women’s Health Strategy for England. During the consultation process, it came out that access to fertility services differs greatly across the country—possibly one of the reasons that many women went to Apricity in the first place. Part of the solution that was proposed to tackle these disparities was a target to establish women’s health hubs. I understand that the current Government have decided not to go ahead with these women’s health hubs. My question is not why, but how the Government envisage tackling these disparities without women’s health hubs. What is the strategy for doing that?

[Baroness Merron (Lab)]

Women’s health hubs—which are a huge success and we continue to support and promote them, without any shadow of a doubt—do not deal with fertility treatment in the way this Question is discussing. I gently point out to the noble Lord that, as he rightly said, commitments were made to improve access to fertility services, which is very variable across the country. They were made under the last Government’s women’s health strategy but, regrettably, were not delivered. It now falls to us to look at how we can improve both availability and quality, and to equalise what is available, which is a huge challenge. This continues to concern me.