Tobacco and Vapes Bill

Lord Kamall Excerpts

2nd reading
Wednesday 23rd April 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, I begin by declaring my interests as set out in the register. I am an unpaid member of the Academic Advisory Council of the Institute of Economic Affairs and have written for the Politeia think tank, both of which have published on health issues. The former has also examined some of the evidence published by the Government and others on the Bill. As a professor of politics and international relations at St Mary’s University, Twickenham, I am helping it set up its new medical school and am giving it advice on that. I am a visiting scholar at the Vinson Centre at the University of Buckingham, which also has a medical school. I am also an unpaid member of the advisory council of the Startup Coalition, some members of which are health-related start-ups, and some are perhaps even related to smoking cessation. I just wanted to be clear and get all that out.

This has been a long but excellent debate with many speakers—so long, in fact, that I suspect that noble Lords who are members of the informal Terrace smoking club will be longing to reach for their cigarettes or vapes. In detaining them a little longer, I thank all noble Lords who took part in today’s Second Reading. I am also grateful to the Minister for introducing the Bill in her usual clear way, and to her officials for meeting us earlier.

We have heard a range of views. At one end of the spectrum, there are those who believe that smoking should be banned as soon as possible and in as many places as possible. At the other end, there are those who see the debate in terms of freedom of choice and the right to smoke despite knowing the harm that it causes. Earlier today, when I was discussing this with another noble Lord, he quoted Kingsley Amis to me:

“No pleasure is worth giving up for the sake of two more years in a geriatric home”.


I respect the range of views, but in doing so, I think there are probably a few truths on which I hope we can agree. First, smoking is not good for you. That might sound like British understatement; maybe I should go stronger and say that smoking kills and nicotine is addictive. Secondly, the current evidence suggests that vaping is safer than smoking. The current evidence also suggests that not vaping is healthier than vaping. In recognising these three truths, I appreciate that the Government are trying to achieve a difficult balance—or, as the Minister said earlier, a “nuance”—between these two positions. The first is that vaping is a useful pathway away from smoking. The second is: how do we stop young people from taking up vaping and encourage current vapers to quit? The noble Lord, Lord Rook, very eloquently put the case of how we need to tackle youth vaping.

To achieve this difficult balance, we on these Benches want to see the Government making laws based on evidence, but also in a way that is effective, accountable and pragmatic. My noble friend Lord Howe raised the Government’s additions to the previous version of the Bill, especially the huge number of delegated powers. I thank my noble friend Lord Blencathra, a former chair of the Delegated Powers and Regulatory Reform Committee, for highlighting his concerns over criminal offences being made by secondary legislation or even just by delegated powers. That is something that we will probe from this side.

Among these delegated powers are the new powers in Part 7 to expand smoke-free places and impose further restrictions on where people can vape. We will want to probe whether it would be more appropriate to put it on the face of the Bill to make healthcare settings, children’s playgrounds and educational establishments smoke-free, rather than relying on the intention of some future Government. We should also consider the evidence for expanding vape-free areas, given the current lack of evidence about the harms of second-hand vape inhalation, and as that evidence evolves, we should find ways of reacting. I can understand that as an argument for delegated powers, but we have to get that balance right and not use it as an excuse.

We will also want to probe the possible unintended consequences of being seen to treat vaping and nicotine products in the same way that we treat tobacco products. As the noble Baroness, Lady Fox, mentioned, research has shown that approximately 50% of all UK adults believe that vaping is as harmful as, or even more harmful than, smoking. We know that current evidence does not suggest that. This is despite the fact that the NHS website says:

“In 2022, UK experts reviewed the international evidence and found that ‘in the short and medium-term, vaping poses a small fraction of the risks of smoking’”.


It also says:

“Vaping has not been around for long enough to know the risks of long-term use. While vaping is less harmful than smoking, it is unlikely to be totally harmless”.


We will probe whether placing similar restrictions to those on cigarettes on vaping and nicotine products will unintentionally deter current smokers from switching to less harmful vaping products.

A number of noble Lords, including the noble Lord, Lord Dodds, raised the impact of the Bill on small businesses, as did many of my noble friends, including my noble friend Lord Sharpe. Small independent retailers and convenience store owners have faced increased costs, such as the increase in national insurance contributions and the national minimum wage. Whatever their merits, the cost of those increases has clearly been passed on to small businesses.

Some worry about the cost of the Employment Rights Bill and now there is the additional licence fee for implementing the generational sales ban and the advertising ban on nicotine products. There will also probably be further regulations and restrictions under the number of secondary powers in this Bill.

I will quote Gurpal Jhutty, who runs a Nisa local in Leamington Spa. In a submission to the Public Bill Committee in the other place, he said:

“Look, I’m not a lobbyist. I’m not a politician. I’m just a shopkeeper trying to make a living, and I’m writing to you today because the proposed Tobacco and Vapes Bill has me seriously worried about the future of my business. You can consider this a retailer’s plea for common sense … I’m tired of being ignored. Retailers are on the front lines of this issue, and we have valuable insights to offer. Let’s ditch the bureaucratic nonsense and work together to create a policy that actually makes sense”.


Let me be clear: we are not asking to ditch this Bill, but we will probe it to create a Bill that is workable and makes sense.

The noble Lord, Lord Scriven, and the noble Baroness, Lady Fox, have rightly raised concerns about personal liberty, problems with prohibition and the practicality of the measures, especially age differentiation. We have heard both sides of that debate.

Noble Lords, including my noble friend Lord Brady and the noble Lord, Lord Teverson, have pointed out that smoking cannabis is illegal but is pervasive in many parts of London. The point is that this is not a Bill against smoking; it is a Bill against the sale of tobacco and vape products. We have to be clear about that.

Having said that, Inga Becker-Hansen of the British Retail Consortium told the Public Bill Committee on 7 January:

“in 30 years’ time if you have someone who is 45 versus 44 from the date of January 2009, it may lead to ID for each sale of a given product … Points of sale can be a flashpoint for violence and abuse against retail and shop workers, so it is a real concern for retailers”.—[Official Report, Commons, Tobacco and Vapes Bill Committee, 7/1/25; col. 58.]

We will also probe the impact of this Bill on the illicit trade in tobacco and vaping products. HMRC has estimated that in 2022-23 illicit tobacco accounted for 14.5% of the total UK market. Current estimates show that illicit vapes account for about 30% of the total vaping market. A 2024 report by the Home Office’s National Business Crime Centre found that the provisions in this Bill mean that

“the demand for illegal tobacco products is set to grow dramatically”.

We have to be careful about these unintended consequences.

Like my noble friends Lord Naseby and Lord Leicester and the noble Baroness, Lady Hoey, we will want to probe whether restrictions on vaping products could lead to an increase in the illegal trade, leading to a risk of more dangerous and unregulated products being used and finding their way into circulation. We are all united in wanting to tackle illicit and illegal products.

Noble Lords, including my noble friend Lord Murray, have expressed concern that the Government appear complacent about the illicit tobacco trade. While they rely on figures that show a drop in illicit tobacco sales, a Europe-wide report from KPMG—based on looking at discarded tobacco packages, rather than on assumptions and mathematical formulae—reported an increase in illicit consumption in the UK in 2023. I understand why these figures have been dismissed, because the report was funded by a tobacco company; I completely understand that reasoning.

However, I would be interested in understanding whether the Government will commission similar research looking at discarded tobacco packets as a method of understanding the illicit tobacco trade. If they will not, can they explain why—not immediately, but in writing? Could they explain why they have doubts about this methodology and prefer the formula used by HMRC, which has been criticised by many people for the assumptions it makes around smoking? We will be probing the Government on this and on what action they will take to tackle this rise in illicit sales. We know that all noble Lords will agree on tackling illicit sales of illegal products.

Finally, I am a huge believer in the role of local community non-state initiatives that improve people’s health. I have worked with organisations that help to tackle obesity and local financial and other problems. We will probe the Government on what they have learned and can learn from local community initiatives that have reduced smoking. We have not heard enough today about local community initiatives, the people who understand their local communities and the projects in those communities that could reduce smoking. Most of it has been about top-down measures to try and reduce smoking.

Whether noble Lords smoke or not, I hope we are united in our desire to reduce the incidence of smoking-related deaths and share concerns over the rise in youth vaping. I am also sure many of us will want to help the Government achieve an appropriate balance based on evidence, pragmatism and proportionality. I thank all noble Lords who spoke and look forward to the many days of debate ahead.

Mental Health Bill [HL]

Lord Kamall Excerpts

3rd reading
Wednesday 23rd April 2025 Lords Chamber

[Baroness Merron (Lab)]

My Lords, it has been an extraordinary honour and pleasure to take this Bill through the House with my noble friend Lord Timpson. As we are all aware, numerous aspects of the Mental Health Act 1983 are not serving us today. Over the decades, we have seen racial inequalities, inadequate care for individuals with learning disabilities and autism, and insufficient empowerment of patients who have not had an adequate voice.

Reform to the Mental Health Act is therefore long overdue. Many of the processes in the Act are out of step with a modern mental health system and with society at large. It has been a privilege to advance these reforms to deliver the Government’s manifesto commitment to modernise the Act to give patients greater choice, autonomy, enhanced rights and support, and to ensure that everyone is treated with dignity and respect throughout treatment, while ensuring that patient and public safety is paramount.

As noble Lords will be aware, this Bill is the product of the combined effort, over many years, by Members of both Houses and many outside Parliament who have worked for change and to whom thanks are due. I express my sincere gratitude to members of the former Joint Committee on the Draft Mental Health Bill: the noble Baroness, Lady Buscombe, as chair, as well as my noble friends Lord Bradley and Lady McIntosh of Hudnall, and the noble Baronesses, Lady Barker, Lady Berridge and Lady Hollins. The work and careful consideration that went into their rigorous scrutiny of the draft Bill, along with the constructive recommendations made, have undoubtedly strengthened it.

I pay tribute to the former Prime Minister, the noble Baroness, Lady May, who identified the need for modernisation and set up the independent review of the Act in 2017, chaired by Sir Simon Wessely and supported by the noble Baroness, Lady Neuberger, as one of the vice-chairs. Without this, we would not be here today.

I extend my heartfelt thanks to all Peers who have engaged with the Bill’s reforms. In addition to those previously mentioned, gratitude is due to both Front Benches—to the noble Lord, Lord Kamall, the noble Earl, Lord Howe, the noble Lord, Lord Scriven, and the noble Baroness, Lady Tyler. I am grateful to all noble Lords from across the House who have spoken during the various stages of the Bill and engaged with me and my officials over the past few months.

Because I would like to think that I am wise, I also thank my Whip, my noble friend Lady Blake, and my previous Whip, my noble friend Lord Cryer. I thank the Chief Whip and the whole of the Whips’ team and the team in the Leader’s office, including Ayeesha Bhutta and Michael Bleakley. My appreciation, as ever, goes to the clerks, doorkeepers and staff of the House.

I extend my heartfelt gratitude to all the officials who have played a crucial role in the progression of this Bill, and hope your Lordships’ House will indulge me while I give them the honour of mentioning them by name, because I believe they deserve it. Special thanks go to Phillip Dunkley, our Bill manager, and his dedicated team, Callie Mulligan, Sam Monday, Emily Bouldero and Rhys Jose. I am deeply appreciative of the Bill’s senior responsible owners, Kathy Smethurst and Caroline Allnutt, as well as the DHSC officials, including Esther Horner, Hannah Coaker, Alice Devlin, Matt Siddons, Tabitha Mufti, David Nuttall, Jennifer Rhodes, Megan McIvor and Mihiri Seneviratne, and their teams.

Additionally, I want to acknowledge the invaluable contributions of the Government Legal Department officials, Matt Smith, Lizzie Rattee, Nicky Richardson and Tim Spencer Lane, and their wider team, along with my private office staff, including Carl Plane and Yetunde Agaga, as well as Diggory Bailey and Victoria Griggs from the Office of the Parliamentary Counsel.

While I cannot list every individual, I express my appreciation to all officials who have played a part, including officials from the Ministry of Justice. Their unwavering support and dedication have been instrumental in the successful advancement of the Bill, and their work with Peers—as noble Lords across the House will testify—has been exemplary. I am confident that this legislation will make the Mental Health Act fit for the 21st century and give greater and better support to people when they need it. I look forward to it receiving support in the other place. I beg to move.

[Lord Kamall (Con)]

My Lords, as the Minister has said, debating the passage of the Bill through your Lordships’ House has been a pleasure. We have seen a genuine spirit of constructive engagement with a Bill that we all acknowledge will help patients who encounter mental health services, as well as a cross-party desire to improve the Bill. This was not a particularly political Bill; we found alliances across political lines and did not play political games. We wanted to improve the Bill and make sure that patients receive the best possible care. That is a wonderful demonstration of the value of this House.

I extend my thanks to all Peers who took part. I also thank the members of the pre-legislative committee whom the Minister acknowledged. Like the Minister, I acknowledge my noble friend Lady May of Maidenhead, the former Prime Minister, who we have to thank for beginning the process that led to this Bill. My noble friend identified the issue of racial disparities in the use of community treatment orders and wanted to reduce the involvement of police where they are not needed. Even though my noble friend was unable to be in her place to speak to her amendments on Report, I am grateful to all noble Lords who supported them, and I am delighted that the House has decided that they should be inserted into the Bill. We look forward to how that will be debated in the other place.

It was also welcome to see the House rally behind my noble friend Lady Berridge’s amendment to ensure that the process for appointing nominated persons for patients under 16 aligns with the Children Act 1989. My noble friend was crystal clear that there has to be consistency between different Bills, and that we do not want people falling between Bills and into harm’s way. She highlighted this and gave some harrowing examples of what could happen if we do not align these Bills. We have to make sure that we align them as much as possible.

I also thank the noble Lord, Lord Scriven, and the noble Baroness, Lady Tyler, for their dedication to improving community treatment orders and addressing racial disparities. Noble Lords will remember that this is probably the issue that was closest to my heart, and we probed the Government heavily on it. There are still too many racial disparities. We understand that it is a complicated issue, but the Government assured the House that they are looking into the data around this. What do they know? What do they not know? How will they fill that gap and what will they do to address racial disparities? I hope that is something that all noble Lords can agree on.

Of course, I have to thank my noble friend Lord Howe for his stalwart support and advice on this Bill, and for his experience not only of parliamentary procedure but of previous iterations of this Bill. I appreciate his sagacity, and I am grateful whenever he agrees to work with me on Bills—sometimes to curb my schoolboy enthusiasm and keep me on the right path. I am grateful that he has agreed to work with me on the Tobacco and Vapes Bill, which your Lordships will debate later today.

I also thank the Minister—and of course her noble friend, the noble Lord, Lord Timpson—for taking time at the Dispatch Box, and for the fact that the Minister and her officials were always available to meet us to try to iron out some of the disagreements or find compromises. That is very much appreciated by all noble Lords in this House. I thank Ben, the special adviser in her office, for his input, and, in our office, our adviser Jamie Tucker, who was amazing in his understanding of the Bill.

I will end by mentioning a quote that was sent to me and my noble friend Lord Howe from the charity Blooming Change. On hearing that the House had voted in favour of my noble friend’s amendment on mandatory debriefing for mental health patients, a younger person told the charity:

“I genuinely for the longest time felt like I didn’t matter, to anyone or anything, that the universe didn’t need to hear my voice, that what I went through didn’t matter. It took so long to build my confidence and to find my voice … I’m glad I decided to use my experiences to fight for change and I’m so happy our words have made a difference. We will keep fighting for more changes, little by little”.


As the Bill now progresses to the other place, I hope all Members involved will heed those wise words.

[Baroness Tyler of Enfield (LD)]

My Lords, it has been a privilege to be involved in scrutinising and improving this vital Bill, for which we had waited so long. Our debates have been, rightly, exhaustive, and at times—again, quite rightly—passionate. I will make one general observation, which is a point that was made on a number of occasions throughout our deliberations. You get only one chance about every 15 years to reform and modernise mental health legislation, so it is really important to get it right and to include all the relevant issues before the ship sails. Some would like to have seen more fundamental fusion legislation between mental health and incapacity, but that was not on the table, so you work with what you have.

Funerals: Death Certificate Delays

Lord Kamall Excerpts

Thursday 3rd April 2025 Lords Chamber

[Baroness Merron (Lab)]

I do not have the figures to hand, but I would be very pleased to write to the noble Lord. As I said, this is a complex area. The reforms were introduced in September, and it is very difficult to make before and after comparisons. Since 2001, a long-term trend has shown an increase in the median time between death and registration, and that cannot be attributed to death certification reforms. In addition, the reforms are about the introduction of statutory medical examiners as opposed to the non-statutory arrangements that existed before—and there was even more regional variation before September than we are finding now. I assure your Lordships’ House that I am working very closely with officials to understand the reasons for this so that we can take more action.

[Lord Kamall (Con)]

My Lords, I thank the noble Viscount, Lord Stansgate, for the conversation we had about this Question. As we all know, when a loved one passes away, it is a distressing time, and surely delays can only add to that distress. I am sure that noble Lords understand why these reforms were brought about in the first place: they were introduced after a qualified doctor, Harold Shipman, murdered his patients and signed the death certificates himself. In a recent Written Answer on these delays, the Minister for Public Health in the other place said:

“The expectation on doctors and medical examiners is clear … they should complete certification as quickly and efficiently as possible, and the Government is working with all stakeholders to make sure this is the case”.


Can the Minister explain to your Lordships what that means? Is the department simply asking them to complete the certificates, or is it identifying blockages or misunderstandings in the system to help unblock them in order to speed up the process?

[Baroness Merron (Lab)]

The noble Lord’s observations are correct. As I said, it is so important to be timely and sensitive at a time of bereavement. Governments and Ministers have been working to bring in the system over the last 50 years—in fact, it has been overdue for reform for that long, so I am very glad to have taken this action. Introducing this robust system means working with medical examiners as well as the bereaved, so that we hear from them about what has happened. We also work very closely across government, including with the MoJ and the Home Office. As the noble Lord will know, the medical examiner system is led by NHS England through the office of the National Medical Examiner. I reiterate that delays are not due solely to this introduction; it is very important to unpick this issue. We now have better data and get weekly reports, which is helping greatly.

NHS Pensions

Lord Kamall Excerpts

Thursday 3rd April 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, in the other place, in response to a question from the honourable Member for North Shropshire, the Minister there said:

“HMRC has also confirmed that self-assessment late filing penalties will be waived on appeal in certain circumstances where a member receives a delayed pension savings statement as a consequence of the implementation of the McCloud remedy”.—[Official Report, Commons, 1/4/25; col. 166.]


One of the frustrations that people sometimes have when dealing with government or large organisations is that their advice is not always clear. I want to ask the Minister two questions. Can she explain to your Lordships the specific “certain circumstances” where the penalty will be waived, and can she explain the thinking behind the Government deciding not to waive the penalty for everyone affected, given that responsibility for delays is with the NHS and not with those affected?

Mental Health Bill [HL]

Lord Kamall Excerpts

Report stage
Wednesday 2nd April 2025 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, I have attached my name to Amendment 47, in the name of the noble Baroness, Lady Tyler, and I raised this issue at Second Reading.

A powerful case has already been made for a mental health commissioner, so I am just going to make one comparison here. At the same time as this Bill has been going forward, in the other Chamber I have been dealing with the Armed Forces Commissioner Bill. An Armed Forces ombudsman was created, which in some ways has parallels with the Chief Inspector of Mental Health and the CQC. It was found that that was not effective or strong enough, and now the Government themselves are going for the Armed Forces commissioner model.

There is another parallel. One of the reasons why it is felt so strongly that there needs to be an Armed Forces commissioner model is that members of our Armed Forces do not have the same rights. They have certain responsibilities laid on them and are treated differently from other members of society, which is why they need a special advocate. The parallel with people who are potentially subject to the Mental Health Bill is obvious.

In the health space, I have been heavily involved over the years with the Patient Safety Commissioner, which was initially resisted by the Conservative Government of the time. Eventually the fight was won, and it is now seen to be a huge success. This is a model that we can see working and that is seen to be necessary.

The Government have expressed a desire to get rid of arm’s-length bodies and make decisions themselves. The Government devolve decision-making to those so-called quangos—the arm’s-length bodies—but that is not the case with the Patient Safety Commissioner; there is no parallel here. They are a person who is there as an advocate and to have oversight; they are not making decisions. I do not think the Government can shelter under that umbrella.

[Lord Kamall (Con)]

My Lords, I thank the noble Baroness, Lady Tyler, for, as others have said, the eloquent way in which she introduced her amendment.

I know this is a topic that noble Lords across the House feel strongly about, and I appreciate the arguments in favour of the creation of a commissioner. Indeed, as other noble Lords have said, it was a recommendation of the pre-legislative Joint Committee.

Having listened keenly to what the noble Baroness has said, and having discussed this issue with her and her noble friends, I have to say that I agree with the noble Lord, Lord Bradley, when he says that the landscape has changed. We are now at a time when the Government are looking to reduce duplication and arm’s-length bodies—something that I believe a responsible Opposition should support. We believe it should not be necessary to have a new, separate, independent mental health commissioner.

We were going to group this amendment with the ideas about strengthening the CQC, but that has been ungrouped and we will talk more to it in the next group. When I had some conversations with those who supported the independent mental health commissioner, they said I should look to Children’s Commissioner as an example. I looked at the Children’s Commissioner; it does a great job, but it has a staff of 25, a temporary staff of 31, and expenditure of £3 million. That may not sound a lot of money but I wonder whether that amount of money could be better invested in strengthening the CQC. One of the things about any bureaucracy is that they grow and have more non-essential roles as other bits of legislation bring them in. I worry about the cost and duplication of functions.

I completely understand the argument from those who say that the CQC has not been doing its job and those who have criticised it for being ill-equipped. That is why we tabled our amendment, which will be discussed in the next group, about strengthening CQC functions. However, rather than saying all that now and repeat it in the next group, I do not wish to detain the House any longer. I believe there should be a comprehensive review of the CQC and proper accountability, and I hope we can achieve that without an independent commissioner.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I thank all noble Lords for their contributions on this fiercely and keenly debated proposal. Amendment 47, in the name of the noble Baroness, Lady Tyler, leads me to say that we continue to be of the strong view that the functions of the proposed commissioner, as set out in the amendment, would clearly overlap with the existing responsibilities of other organisations, most notably the CQC. I must respectfully disagree with the noble Baroness: the CQC has a statutory role in monitoring the Mental Health Act. It publishes an annual report that serves to drive policy improvements in this area.

--- Later in debate ---

[Baroness Browning (Con)]

I am very grateful for that response. The noble Baroness said that autism is different; it certainly is different, which is why it has its own Act of Parliament.

[Lord Kamall (Con)]

My Lords, as I said on the previous group, I will start by speaking to the amendment in my name and that of my noble friend Lord Howe. It would require the Secretary of State to conduct a review into the ability of the CQC to effectively fulfil its role

“in carrying out its duties under the Mental Health Act 1983, and … in regulating the provision of mental health services”.

We have also included proposed new subsection (3), which would ensure that the review of the CQC’s functions will also include an assessment of whether it will be able to “effectively carry out” its new duties under the Bill.

As the Minister will know, in May 2024, Dr Penny Dash was commissioned to conduct the independent review of the operational effectiveness of the CQC. The full report, published in October, found

“significant failings in the internal workings of CQC which have led to a substantial loss of credibility within the health and social care sectors, a deterioration in the ability of CQC to identify poor performance and support a drive to improved quality—and a direct impact on the capacity and capability of both the social care and the healthcare sectors to deliver much needed improvements in care”.

In addition, my noble friend Lord Howe raised the issues arising from his meetings with the charity Blooming Change on a number of occasions. It has raised serious concerns about the CQC’s monitoring activity. We also know that the Secretary of State himself has claimed that the CQC is not fit for purpose, and that there are some fundamental issues with how the CQC oversees the mental health care system.

As we have heard from other noble Lords, one solution would be to have an independent mental health commissioner. Our solution is to call for a review of the CQC that specifically focuses on its mental health functions, to make sure that it does its job properly. The review conducted by Dr Dash comprehensively assessed the CQC’s ability to regulate primary, secondary and community care, but it did not focus on the sufficiency of mental health care regulation. I thank the Minister for the brief meeting with my noble friend and me earlier this week, in which she indicated that she would be able to give greater assurances on this particular issue. I look forward to what the Minister has to say on it, because this is part of our justification for not supporting the mental health commissioner: we want to see a strengthened CQC. We do not want duplication, but, in avoiding duplication, we want to make sure that the CQC does the job it is supposed to do. I hope I can get that assurance from the Minister when she speaks.

I have some sympathy with Amendment 61, in the name of the noble Baroness, Lady Fox, in line with the comments of the former Prime Minister, Tony Blair, but I also have some sympathy with what the Secretary of State said. We thought about whether we could find an appropriate amendment to table on this. We have to be very careful and sensitive about this issue: we in Parliament or officials in Whitehall cannot hope to pronounce on the issues individuals face in their homes or communities. It is about getting the balance right.

The noble Lord, Lord Alderdice, also spoke about the concerns about overdiagnosis, but we cannot just make a generalisation. We have to make sure that the mental health professionals are doing their job, with the right guidance, to ensure that we understand the needs of each individual. For that reason, I thought it was far too difficult—and it would have been insensitive —for me to lay an amendment on this topic. I did not want to go there for that reason. This is an issue that has to be discussed, but we have to do it in the most appropriate way—in a sensitive way that understands those who suffer seriously from mental health conditions.

Let me turn to the amendments tabled by the noble Baroness, Lady Tyler. She and I have both raised the issue of racial disparities. In Committee, I went in very strongly on it—this is the issue that matters to me personally very much, and I shared some of my own experience of racial discrimination. I am as frustrated as everyone else that we still have not resolved the problem to this day; we still do not understand why, disproportionately, black men in particular are subject to detentions and community treatment orders. I asked questions at the time. What do we know? What do we not know? What are we doing to fill that knowledge gap? Once we have filled that knowledge gap, what are we going to do about it? Once again, I thank the Minister and her officials for the detailed meetings that they had with us when they laid out some of the things that they are doing. Could I tempt her to share with noble Lords some of that discussion and her letter, to assure us all that the Government really are on top of that issue, know what they are doing and are going to address these problems?

I was unsure about how effective the provision in Amendment 49 would be. I know that it is not very fashionable for politicians to say, “I don’t know”; we are supposed to make a firm decision one way or the other and agree or strongly disagree. But I wanted to reflect on whether that amendment would represent an additional burden on the healthcare professional, additional cost or additional bureaucracy. Given that we cannot, at this stage, say for sure how this will turn out, I support the suggestion of the noble Baroness, Lady Tyler, to pilot a scheme of a senior responsible person to address racial disparities. If we could pilot it in some places, it would give us the data to understand whether a responsible person would be effective in addressing those disparities. We all know that more needs to be done. We have had successive Governments of all political colours, and we still have not solved this problem. Let us be determined, as a House, whichever party we are, to tackle this problem of racial disparities, and let us make sure that we do it in the most effective way.

I am grateful for what the Minister said on Monday, but I hope that she will give some consideration to what the noble Baroness, Lady Tyler, said about piloting a responsible person to see whether that works. Maybe it will not work, but at least we would have the data and evidence. I would appreciate the Minister giving a more detailed explanation of some of the research that is being conducted to fill that gap, so we can understand why there are still racial disparities and what Governments of any political colour would have to do to address them.

[Baroness Merron (Lab)]

My Lords, I thank all noble Lords for their contributions on this important and somewhat wide-ranging group of amendments.

I turn first to Amendment 48, tabled by the noble Baroness, Lady Tyler. We very much recognise that there are inequalities in the use of the Act between different demographic groups, and particularly that there are significant racial disparities. The noble Lord, Lord Kamall, has rightly expressed some frustration with the fact that we all find ourselves where we are today.

To those points, I would say that these inequalities are explored in the impact assessment published alongside the Bill. I reiterate how grateful I am to Peers who recently attended our round table to examine research findings and ongoing work to address racial disparities under the Act. I am glad to hear that the noble Baroness, Lady Tyler, found it helpful—as indeed I did.

I offer the assurance that NHS England already publishes the Mental Health Act Statistics annual reports, broken down by ethnicity and other demographic information, including gender, age and index of multiple deprivation decile. We are improving the data through the patient and carer race equality framework, and we will monitor these inequalities as part of the overall monitoring and evaluation of the reforms.

Furthermore, as I announced on day one of Report, I commit to update Parliament annually on our progress with implementation, including racial disparities. I also committed to undertake further investigation into racial inequalities under the Act. As far as possible, we want to better understand where disparities are most significant across the patient journey, what drives those disparities and, most importantly, where we can most effectively intervene to reduce those inequalities. I very much look forward to keeping Peers updated on those findings, as the noble Lord, Lord Kamall, has rightly requested.

--- Later in debate ---

I say to the noble Baroness, Lady Fox, that this is an important area, and we are keen to take a closer look and, as ever, follow the evidence. We are looking into the best way of getting into these questions and addressing these issues. I hope that my words and promised actions have given reassurance—

[Lord Kamall (Con)]

I am sorry to interrupt. Just to go back to my amendment on the CQC, one of the arguments for those who believed in creating an independent mental health commissioner was that they would be a voice for the patients. With that strengthened role for the CQC, where is that voice for the patients? That was one of the justifications for those arguing for creating a mental health commissioner. We decided not to support that because we thought that function should be part of what the CQC does. Could the Minister reassure us on that point?

[Baroness Merron (Lab)]

For me, it is about not just somebody speaking for others but getting those voices heard. I hope that the noble Lord and all noble Lords have heard my acknowledgement of the importance of that. Those with lived experience need to be properly heard and their voice amplified. I have given a number of reassurances on that point.

With that, I hope that the noble Baroness can withdraw her amendment.

--- Later in debate ---

[Lord Scriven (LD)]

My Lords, because of the lateness of the hour I will be very brief. These Benches support the aim of the amendment in the name of the noble Baroness, Lady Bennett of Manor Castle. It is important that, throughout all this, there is an element not just of treating the acute phase of mental ill-health but trying to ensure that prevention is there within the health service and across the whole of government, national and local. We believe on these Benches that a mental health commissioner would have been really helpful for that, as they could highlight elements that could help with prevention—but the House has made its decision on that.

I have only one question for the Minister. One of the three shifts of the Government is towards prevention. How do the Government see prevention of mental ill-health fitting into that shift, not just in NHS services but, as I said, across the whole of government, including local government, to determine how they can use their resources and levers to bring about what the noble Baroness, Lady Bennett of Manor Castle, is trying to achieve?

[Lord Kamall (Con)]

My Lords, this will probably be the last time I speak on Report—and I am sure many people are grateful for that. Before I make my last remarks, I want to put on record my gratitude to the Minister, her officials and the Whips for the amount of time they have given us in discussing a lot of these amendments. It is certainly appreciated by our side and, I am sure, by other noble Lords.

Given the time, I will not take another hour. The sentiment behind this amendment is unquestionable. During my time as Minister, I was repeatedly reminded of the need to focus on prevention, and of course I agreed to that. As we know, the noble Lord, Lord Darzi, in his report on the state of the NHS, repeated his emphasis on the shift to prevention. If we believe in parity of esteem, where possible, this should be applied to mental health.

If we can shift from a situation where we are treating patients and repeatedly detaining them, such that they are detained for longer, to a scenario where we can treat and prevent those conditions worsening, our mental health system will be better for it. I am sure that all noble Lords can agree with this. So we strongly agree with the intent here, which is in line with one of the Government’s other intentions: a shift from hospital to community.

However, when I have discussed this amendment with others, I have heard one concern that I am still reflecting on. This amendment states that ICBs, local health boards and local authorities must implement preventive policies. It has been suggested to me that this might be too prescriptive or may place a duty on smaller bodies that may not necessarily have the resources to implement such policies. Those who suggest this tell me that it may appear more reasonable to place that duty on the Secretary of State or the Department of Health and Social Care, which have the capabilities and resources to implement preventive measures. Such a policy could work if the department had to work with ICBs and local authorities, as well as local community non-state civil society organisations, to move towards preventive care. As I said, I am still reflecting on this, but I do not wish to detain the House while I make up my mind. So, with that, I look forward to the response from the Minister.

[Baroness Merron (Lab)]

My Lords, I thank all noble Lords for their contributions on Amendment 63A in the name of the noble Baroness, Lady Bennett. I am grateful for the appreciation of the noble Lord, Lord Kamall —and the appreciation shown throughout Report—for the whole team. Similarly, I reciprocate thanks to all noble Lords and their offices for their assistance in improving the Mental Health Bill.

As the noble Baroness observed, we agree with the intention of the amendment: there must be a focus on prevention and the commissioning of services must reflect the needs of the local community. However, we do not feel that it is necessary to place this requirement in statute. As the noble Baroness knows, the Government are currently co-developing the 10-year health plan with the public, staff and patients. As part of this, we are exploring ways to stimulate the shift from sickness to prevention so that we can deliver an NHS fit for the future.

I turn to the points raised by the noble Lord, Lord Scriven. First, progress is already being made to transform community mental health services. In the last 12 months, more than 400,000 adults have received help through new models of care that aim to give people with severe mental illness greater choice and control over their care. We are going further by piloting the 24/7 neighbourhood mental health centre model in England, building on learning from international exemplars such as those in Trieste, which I know the noble Baroness, Lady Bennett, has taken a great interest in. Six early implementers are bringing together their community, crisis and in-patient functions into one open-access neighbourhood team that is available 24 hours a day, seven days a week. This means that people with mental health needs can walk in or self-refer, as can their loved ones.

ICBs are already required to have policies that reflect their communities under the National Health Service Act 2006, as amended by the Health and Care Act 2022. Section 3(1)(i) of the NHS Act 2006 also specifies the duty of an ICB to commission certain health services, including

“such other services or facilities for the prevention of illness”.

An integrated care board must arrange for the provision of services

“to such extent as it considers necessary to meet the reasonable requirements of the people for whom it has responsibility”.

ICBs and their partner NHS trusts and foundation trusts, including their mental health trusts, are also required to prepare a joint forward plan, which describes how the ICB will arrange for NHS services to meet their population’s physical and mental health needs.

Given that these duties already exist, given the Government’s commitment to a shift from sickness to prevention, and given the progress being made on community transformation and expansion of crisis services, we do not consider that it is necessary to create any additional duties within the Mental Health Act and I hope the noble Baroness will feel able to withdraw her amendment.

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.

--- Later in debate ---

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.

--- Later in debate ---

[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.

--- Later in debate ---

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.

--- Later in debate ---

[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.

--- Later in debate ---

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?