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.

Autism and Learning Disabilities: Hospital Detention

Lord Kamall Excerpts

Tuesday 11th March 2025 Lords Chamber

[Baroness Merron (Lab)]

The noble Baroness is quite right to raise the fact that at the end of January 2025 there were some 2,065 people with a learning disability, autism, or both, in mental health in-patient settings. The population I referred to is not a static one; there are new admissions every month. We know, for example, that in January 2024, some 10,000 discharges to the community had been undertaken since 2015. So it is not necessarily the same group of people. She will know that funding decisions are made at the appropriate point. Again, this is a matter of great importance to the Mental Health Bill, and we will continue to take that through the House to get it into the best place possible.

[Lord Kamall (Con)]

My Lords, during the 45 years that this poor autistic lady with learning disabilities was detained and the 25 years she was in segregation, we have had Governments of all political colours, so this is clearly not a political issue. Indeed, I remember the Minister challenging me on such detentions when I was in her place. Given that, are the Government any closer to understanding the barriers that prevent such patients from being released into the community? Rather than assuming that the state always has a solution, have the Government and the NHS had conversations with local community civil society organisations so that they can support these patients once they are released into the community?

[Baroness Merron (Lab)]

This matter is one of concern on all sides and yes, indeed, we continually have those discussions, because this is not just something for the NHS and social care—the third sector is absolutely key. I have already outlined the measures we are currently taking and the way in which we continue to monitor.

On the question about obstacles, it is about having the right community provision in place and also about having the right pathway and treating people as individuals. Increasingly, that is the case, and a revised Mental Health Act will be a tremendous support in this area.

Food and Feed (Regulated Products) (Amendment, Revocation, Consequential and Transitional Provision) Regulations 2025

Lord Kamall Excerpts

Monday 10th March 2025 Grand Committee

The requirement, now to be removed, for secondary legislation was introduced as a result of transposing EU regulations into a UK context at the time of EU exit—so much for reducing red tape as a so-called benefit of Brexit; it has clearly resulted in more red tape rather than less. However, as we have seen today, and as another Member of the Committee mentioned, secondary legislation can be helpful to Parliament as it gives parliamentarians an opportunity to keep themselves informed by scrutinising the issue in detail, hearing from the SLSC and asking Ministers questions, as we are doing today. In future, the onus will be on Parliament to keep itself informed, which will be challenging given the number of issues that cross people’s desks every day. Will the Minister consider whether there is any way in which the FSA could be asked to assist Parliament, such as by laying regular parliamentary Statements about any changes to authorisations every few months? That would help us enormously and avoid us having to do all this.

[Lord Kamall (Con)]

My Lords, I welcome the noble Lord, Lord Moraes, to his place. We served together in the European Parliament, of which he was a well-respected member. I thank the Government for sending out so many big guns—I think I count six on the Front Bench in this Room. I will not flatter myself that they are here for me, but I am impressed by how seriously the Government are taking this statutory instrument.

I thank the Government for addressing the concerns of the Secondary Legislation Scrutiny Committee. The noble Baroness, Lady Walmsley, rightly said that questions were not answered, but it is good that the Government were able to address those concerns, and we are grateful for that. Like my noble friends Lady Coffey and Lady McIntosh of Pickering, I think that these Benches generally welcome measures to streamline processes, but I understand potential concerns over the safety and oversight of regulated products. As the saying goes, one person’s safety standards may be another’s red tape. That was something that the noble Baroness, Lady Bennett, alluded to.

We welcome that there was a consultation between April and June 2024. I understand that, while there was broad agreement in principle, there were some concerns and disagreements, which I would like to ask the Minister about today. Before I do that, I shall pick up on the issue of GMOs. Let me clear—I have nothing in principle against GMOs, but for consumers it is important that there is labelling, so that they can make that choice in an informed way. When we were in the European Parliament and negotiating the Transatlantic Trade and Investment Partnership with the US and made the point about labelling GMOs, what was interesting was that the US negotiators would say, “That’s a non-tariff barrier”. If the Government intend to label GMOs, is that an issue that will be brought up in future trade negotiations? The Minister may not be able to answer that immediately, but perhaps she can write to us about it, or ask her colleague who is taking through trade issues at the moment.

The Government claim that these changes will provide businesses with quicker approval times, increasing the return on investment and stimulating innovation. That is of course to be welcomed, but we should always be aware of two things. What happens in the case of negative unintended consequences, and what happens if new evidence comes to light that shows that a product authorised under these terms presents previously unforeseen risks to public health or the environment? That is something that other noble Lords referred to. In a situation where regular renewals are no longer required, can the Minister assure your Lordships if and how products covered by this regulation will be reassessed, if any new data emerges that suggests that they are not as safe as originally thought, especially if these products are already on the market?

I understand that the Food Standards Agency and Food Standards Scotland have the power to conduct evidence-based reviews if new information surfaces, but can the Minister assure us that a less regular review mechanism will not compromise safety? I think that she mentioned the phrase “where necessary”. Can she put more meat on the bone and explain a bit more what that means? What mechanisms are in place to ensure that products remain compliant with safety standards over time? We know that regulation is often outpaced by innovation, so how do the FSA and the FSS plan to stay ahead of new risks or scientific developments with less regular oversight than these renewals once provided?

The second potential concern is that the Government do not appear to have conducted a formal impact assessment of these proposals. Given that these regulations will affect a significant number of products and legislative instruments, could the Minister tell noble Lords whether it is correct that no formal impact assessment was conducted and, if not, why not? Was there an informal impact assessment of any kind, and why was it decided that no formal impact assessment would be needed? Can the Minister assure the public that the full range of potential risks and benefits has been properly assessed?

Finally, as noble Lords may know, I spent 14 years in the European Parliament—not as long as my friend, the noble Lord, Lord Moraes. I was often frustrated by EU regulations, because they were more often than not based on the precautionary principle, or the over-precautionary principle, rather than the innovation principle. It is important that we get the balance between innovation and precaution right—I welcome that. I am not necessarily against divergence between UK and EU regulations, especially when it allows innovation, but could the Minister tell your Lordships what conversations the Government have had with EU counterparts and colleagues in Northern Ireland about the potential impact of these regulations on the Windsor Framework?

Overall, while these Benches welcome the regulations, I hope that the concerns expressed during the consultation, and today by other noble Lords, can be addressed by the Minister.

[Baroness Merron (Lab)]

My Lords, I thank noble Lords for their valuable and considered contributions to the debate today. I re-emphasise the main point I made in my opening comments: removing automatic renewal processes and statutory instrument requirements will not lower food safety or standards. I am grateful for the support from the noble Baroness, Lady Coffey, and for her bringing to bear her experience across relevant departments, as well as from the noble Baroness, Lady McIntosh, and the noble Lord, Lord Kamall.

I have heard a number of concerns, including from the noble Baronesses, Lady Bennett and Lady Walmsley. I understand the points made, and I hope that I can reassure them further from my opening comments. I am very happy to follow up where I have not got the ability, time or wherewithal to answer the questions.

The noble Baroness, Lady Coffey, asked about ministerial decision-making and the assertion of the non-discrimination principle. These reforms do not change what is in place to maintain the functioning of the internal market Act. Differences in approach will continue to be managed through the relevant common frameworks. I reassure not only the noble Baroness but other noble Lords that the FSA and the FSS are strongly committed to achieving a four-nation consensus, in line with our commitment to the food and feed safety and hygiene common framework. Decisions by Ministers in England—which will be from the Department of Health and Social Care, to the point brought up by the noble Baroness—as well as Scotland and Wales, will still be required for authorisations in their respective nations.

The noble Baroness, Lady McIntosh, asked about processes that will be followed with the removal of the renewals process. This SI does not change current GMO labelling requirements, which I know was another matter of concern to other noble Lords. Products that contain or consist of GMOs must be clearly labelled as defined in current legislation. Nothing will change in that regard. Following the reforms, businesses will continue to be required to notify the FSA and the FSS, if they have any new information which might affect the suitability of a validated laboratory-based method for the identification, detection and qualification of GMOs, something that the noble Baroness, Lady Bennett, was also concerned with.

To the point about the SLSC, it is suggested that the House may wish to consider the steps proposed to maintain parliamentary oversight. However, proportionate processes are in place for sufficient scrutiny of authorisation decisions, such as public consultation and the publication of safety assessments and authorisations. It is an important point that the authorisation process remains open and transparent. The SLSC recognised that this aligned with the processes used by other UK regulators.

Prostate Cancer: National Screening Programme

Lord Kamall Excerpts

Thursday 27th February 2025 Lords Chamber

[Baroness Merron (Lab)]

I was glad to have the opportunity to discuss this with the noble Baroness. Having looked into it, we do not currently hold this data. However, where strontium therapy is appropriate and preferred to improve patient outcomes, it will be offered. This is, of course, a clinical decision.

[Lord Kamall (Con)]

My Lords, when I worked in Belgium, a urologist told me that men over 45 years old should seek a test every year for this. When I came back and asked my GP, he was dismissive of that, saying that I should seek a PSA test. When I asked a nurse at my next blood test for a PSA test, she said, “Are you sure? They’re not very reliable”. Given that the last Government introduced trials, and that one of the tests seems to be 96% accurate, can the Minister say any more about that trial and its evaluation, and whether we are any closer to a definitive test? If not, what guidance is available to medical practitioners for the PSA test?

Musculoskeletal Health: Chiropractors

Lord Kamall Excerpts

Wednesday 26th February 2025 Lords Chamber

[Baroness Merron (Lab)]

Working with community-based organisations, including faith communities, has come up a number of times in the 10-year plan consultation, as I am sure the right reverend Prelate will find. I would certainly associate myself with the comments about the importance of getting healthcare provided in the community.

[Lord Kamall (Con)]

I thank the Minister for giving me the time to ask a question. Following the tragic death of Joanna Kowalczyk in October 2021, the coroner has recently raised concerns over the fact that chiropractors are not required to request their patients’ medical records before they begin treatment. While I recognise that there is scepticism from many in the NHS, and in fact physiotherapists, towards osteopaths and chiropractors, will the Government take on board the recommendations of the coroner to look at changing guidance to ensure that all healthcare treatments require consideration of a patient’s medical history, especially as we move toward a digital single patient record that could be shared across our system of health and care?

[Baroness Merron (Lab)]

The noble Lord raises an important point about what is required before healthcare is provided. I can certainly assure the noble Lord that, as I know he is aware, where there is a coroner’s report, we look at all of the lessons to be learned to consider how we might make it a safer and more effective environment for people. Certainly in the case to which he refers, that will happen.

Mental Health Bill [HL]

Lord Kamall Excerpts

Committee stage
Monday 24th February 2025 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I had not intended to come in on this group, but, having just heard the very powerful—and, in places, very alarming and harrowing—speech from the noble Baroness, Lady Fox, I will just ask the Minister whether he can explain what plans the Government have to assess and evaluate the impact of the provisions of the future Act on prisons and the criminal justice system, even if they are not planning a formal review. We need to know how the impact will be assessed.

[Lord Kamall (Con)]

My Lords, during the passage of this Bill, both the noble Baroness, Lady Fox, and the noble Lord, Lord Bradley, who is not in his place, have spoken passionately about people with mental health issues in prison. The noble Baroness, Lady Fox, referred to Valdo Calocane, and I know that the Government have instigated an inquiry. That particular case was the motivation for Amendments 160BA and 160BB in a later group, to which my noble friend Lord Howe will speak.

During the earlier debates on this, both at Second Reading and in Committee, I was particularly struck by the remarks of the noble Baroness, Lady Fox, on Chief Inspector Charlie Taylor’s graphic description of seriously mentally ill people in prisons being akin to a Victorian nightmare. After that debate, I read some of what Charlie Taylor had said, particularly about his visit in 2022 to Eastwood Park, where he witnessed

“bloodstains on the floor and scratch marks on the walls—evidence of the levels of distress of the women being held there”.

The noble Baroness, Lady Fox, also told the Committee about the experience of prison staff, saying that one of the most difficult things is the danger that prisoners with mental health issues pose to themselves, other prisoners and staff. In fact, Charlie Taylor gave an example of an incident when staff were

“unable to stop one inmate from repeatedly running into a brick wall due to a lack of suitable training”.

These are very important issues that the noble Baroness and other noble Lords are raising.

Given all this and its importance—I know that one of the reasons the Minister was appointed to his position was his experience and passion for prison reform—it seems reasonable to ask the Secretary of State to publish a review of the impact of this Act on prisons and to assess whether it provides for adequate support for ongoing treatment and care in those settings, including adequate staff training. I am sure this will be of help not only to the Secretary of State for the Department of Health and Social Care but to the Ministry of Justice. I look forward to the Minister’s response.

[The Minister of State, Ministry of Justice (Lord Timpson) (Lab)]

I am grateful to the noble Baroness, Lady Fox, for bringing this discussion before the Committee today. This amendment would introduce a new clause, making it a requirement for the Secretary of State to publish a review of the impact and assessment of the provisions of the Act that relate to care and treatment of mentally disordered persons in prisons— this includes under-18s in young offender institutions, IPP prisoners and female prisoners—within 12 months of the day it is passed.

The aim of the criminal justice reforms is to speed up access to specialist in-patient care and ensure that offenders and defendants with severe mental health needs are able to access effective and timely support in the most appropriate setting. We are committed to understanding the impact of these provisions as we monitor any available data. However, these reforms will not come into effect until at least 18 months post Royal Assent. This is to ensure that the necessary operational improvements have been made to enable them to be safely implemented.

We are working closely with health and justice partners to ensure that there is a robust implementation plan in place, and we will scope the feasibility of assessing the impact on all prisoners, including under-18s in young offender institutions, IPP prisoners and female prisoners. Our expectation is that the numbers of these cohorts affected in a prison setting will be small and are unlikely to show up in administrative datasets. However, I reiterate that everyone in our care is important—and I thank the noble Lord, Lord Kamall, for his comments about the importance of this to me. We are committed to supporting everyone’s rehabilitation, working to ensure that people stay out of prison by leaving in good health.

I am pleased with the feedback on the noble Baroness’s visit to HMP Five Wells. I too have seen some very ill prisoners in HMP Five Wells and many other prisons. That is why the Bill, and the work we are doing to improve our prisons and the chances of prisoners leaving with a one-way ticket, not a return ticket, are so important.

I reassure the noble Baroness, Lady Tyler, that there is already a robust scrutiny landscape in place. We are accountable to several key stakeholders and bodies, including His Majesty’s Inspectorate of Prisons, independent monitoring boards, the Care Quality Commission and the Healthcare Inspectorate Wales. We are committed to learning from what works and where we can improve support for vulnerable offenders with severe mental health conditions.

--- Later in debate ---

[Baroness Tyler of Enfield (LD)]

My Lords, there has been discussion throughout Committee about whether this Bill and our deliberations should stick strictly to detention under the Act or range wider. I know that there are different views on this issue. I have said consistently throughout our debates that we need to see what more we can do to prevent people reaching the point where the only option is being forcibly detained.

I feel that a key omission is a power around prevention. Given the cost of statutory in-patient admissions under the mental health legislation, and the stated intention of the Secretary of State to reduce hospitalisation through prevention, I find this surprising. Therefore, I have brought forward a simple amendment that would give relevant authorities the power to promote mental ill-health prevention in their communities, while of course being realistic about current financial realities.

My Amendment 160B seeks to explicitly grant relevant bodies, including integrated care boards, public health bodies and local health boards in Wales, the power to promote mental ill-health prevention within their communities. It would also empower organisations such as social care and the voluntary sector to take proactive steps in reducing the likelihood of individuals reaching crisis point and requiring detention under the Act.

I was pleased recently to have the opportunity to discuss this with the Approved Mental Health Professional Leads Network, which is very much involved in this. It expressed its support for such an approach. I think we all understand that the causes of mental health issues are complex and can be as much around societal issues, such as employment, housing and poverty, as clinical issues. That is clearly recognised in the AMHP’s role, which acknowledges that while a clinical perspective is always appropriate, other perspectives can be equally valuable. As was explained to me, at the core of the approved mental health professional’s role is a responsibility to explore less restrictive alternatives to detention for individuals in crisis.

As has been quoted a number of times in this Chamber, recently the Secretary of State said that the Government will publish a 10-year plan early next year setting out how they will deliver three big shifts in the focus of the NHS,

“from hospital to community, from analogue to digital, and from sickness to prevention”.

I see this legislation, and indeed this amendment, as an opportunity to make a reality of that statement in relation to mental health. While there will always need to be provision for statutory interventions for those who present a severe risk to themselves or others, it is surprising to me that, in this journey from hospital to community and sickness to prevention, there is no explicit mention of the promotion of good mental health within the Bill.

There is plenty of evidence of the links between prevention and reducing detention. I was going to give some examples, but the hour is late and noble Lords will be pleased to hear that I am not going to. There are also plenty of examples of alternative approaches to detention, such as crisis cafes and safe spaces, community crisis response teams, mobile mental health and social care professionals who respond to individuals in crisis, peer support networks, sanctuaries and respite services. All these have been shown to be effective in reducing the need for hospital admissions.

To conclude, by formally giving relevant bodies the power—it is a power, not a duty—to promote mental ill-health prevention, this amendment encourages a proactive rather than a reactive approach to mental health care and support, thereby, I hope, reducing reliance on crisis interventions, including involuntary detention. I beg to move.

[Lord Kamall (Con)]

My Lords, I thank the noble Baroness, Lady Tyler, for introducing this amendment. It is quite clear that noble Lords across the Committee agree with the Government’s commitment to move the emphasis from sickness to prevention. This amendment is clearly aimed at that, as the noble Baroness has said.

During my time as a Health Minister and since, I have met a number of community and civil society projects, charities and mental health professionals who have shared the amazing work being done across the country to improve the well-being of local communities. I put on record my thanks to the late Baroness Greengross and the noble Lord, Lord Howarth, for introducing me to the wonderful world of creative health and to the National Centre for Creative Health. Its work addresses the theme of earlier amendments from the noble Baroness, Lady Hollins, and the noble Lord, Lord Crisp, on the overprescribing of antidepressants and looking at alternatives. We are not saying that medication is a bad thing necessarily. It is very appropriate in some cases, but there are alternatives, such as social prescribing.

The late Lady Greengross introduced me to a wonderful organisation called Intergenerational Music Making, and I put on record my thanks for its work. It invited me to take part in one of its intergenerational music hubs in Guildford last December and, despite being handed a guitar to play along, I found it inspiring to see the difference that music can make in improving well-being and bringing people of all ages together, including some children from a local learning disability charity.

Noble Lords will also know of the equally amazing work done by many social prescribing organisations, using music, art, drama and green spaces. A career in creative health also opens up new opportunities for budding actors and rock stars who can train as drama and music therapists while waiting for their big break. But many do not wish to be stars and actually find their work, combining their passion with improving mental well-being, fulfilling in its own right.

However, one criticism I hear is that, although there is amazing work on well-being in different primary care settings or in different trusts and integrated care systems across the country, the challenge is how we spread the best practice across our system of health and care, while recognising that what works in one area may not always be an off-the-shelf solution in another locality.

The amendment from the noble Baroness, Lady Tyler —which says that

“Local authorities and commissioning bodies must publish an annual report outlining the steps taken to discharge their duty”


to promote mental health and well-being—may be a way to address this concern. Given that, I hope it is an amendment that the Government will consider. If not, perhaps the Minister can tell your Lordships how the Government intend to encourage the sharing of best practice in improving mental well-being across our system of health and care, particularly across different communities with different needs and different constraints, in order to improve the mental well-being of the nation.

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

My Lords, I thank the noble Baroness, Lady Tyler, for tabling Amendment 160B. We recognise the importance of local organisations taking collective action to promote mental well-being and prevent mental ill-health. However, turning to the amendment very specifically, we do not feel that this amendment suggests the best approach, as there is potential for introducing unnecessary burdens on local authorities and commissioning bodies. It may also be duplicative of other existing duties, such as the Care Act duty, to promote individual well-being.

However, the noble Baroness, Lady Tyler, and the noble Lord, Lord Kamall—whom I also thank for his contribution—may be interested to note that the existing prevention concordat for better mental health, a voluntary agreement signed by local authorities and integrated care boards across the country, does involve, for those who sign it, a commitment to take

“evidence based preventive and promotional action to support”

population mental health and well-being.

Through the NHS 10-year plan, which the noble Baroness referred to, and as noble Lords are aware, we aim to encourage stronger partnership working between local government mental health services and the voluntary and community sector—which, as we know, plays a vital role, as the noble Lord, Lord Kamall, described—in order to galvanise that shift, which we all seek, from sickness to prevention. On the basis of the reasons outlined, I hope the noble Baroness will withdraw her amendment.

Mental Health Bill [HL]

Lord Kamall Excerpts

Committee stage
Monday 24th February 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, before I begin my remarks, I want to say how pleased my noble friend Lord Howe and I are to see the noble Baroness, Lady Hollins, back in her place; I am sure that many noble Lords would echo that sentiment.

I thank the noble Baroness, Lady Tyler of Enfield, for moving this amendment to establish a statutory mental health commissioner. One of the motivations behind some of the amendments in my name and that of my noble friend Lord Howe is to probe the Government on those recommendations from the pre-legislative Joint Committee that did not make it into this draft Bill. As noble Lords will be aware, and as the noble Lord, Lord Bradley, has said, this is one such recommendation of the Joint Committee that did not make the cut.

We did consider tabling a similar amendment ourselves, but I have to admit that the amendment from the noble Baroness, Lady Tyler, did the job very well; there was no need to duplicate that. Having spoken to the noble Baroness and to her noble friend Lord Scriven, I know this is an issue that they and many other noble Lords feel passionate about. The noble Baroness, Lady Tyler, has today made a very good case for a commissioner. The noble Lord, Lord Scriven, has also spoken of the need for central co-ordination to ensure implementation of the provisions of this Bill—something that was referred to in the last group of amendments.

I pay tribute to the noble Lord as I know that he has considerable experience in the NHS and is all too aware of the problems involved in trying to deliver at scale. However, I admit that I have some reservations about the idea of a mental health commissioner. While I understand the arguments in favour, I am, like the Minister, concerned about the creation of a new bureaucracy that could possibly duplicate functions.

In their response to the recommendations of the Joint Committee, the previous Government noted that

“the government does not believe that a statutory mental health commissioner would add significant value within the framework currently provided by existing bodies”.

The Joint Committee pointed out that a Mental Health Act Commission was established by the Mental Health Act 1983, which stood alongside the Healthcare Commission and the Commission for Social Care Inspection. In 2009, the then Labour Government took the decision to combine these three bodies into one integrated regulator with responsibility for all health and adult social care. I say that not as a political point but as an observation.

Since then, the CQC has undertaken the functions of the previous Mental Health Act Commission, and its remit extends to ensuring protections for those who are detained under the Act or subject to a community treatment order. To do this, the CQC has a number of Mental Health Act reviewers, who can visit patients in hospital and raise concerns about treatment or detention with managers, and then report back to the commission. The CQC also has a dedicated team that assesses complaints about the use of the Mental Health Act, including issues around detention and the use of CTOs.

I also understand that the CQC provides second-opinion appointed doctors for patients who do not have the capacity to consent to treatment under Part 4 of the Act. This Bill strengthens the safeguards around second-opinion appointed doctors, such as creating a clinical checklist that must be certified by the second-opinion doctor.

In addition to the functions of the CQC, local authorities and ICBs provide independent mental health advocates; we have debated those in earlier groups. The Department of Health and Social Care also gives funding to local authorities to commission Healthwatch services, of which I understand there are about 152 across the country. Healthwatch is another statutory organisation that gathers feedback from the users and ensures that NHS leaders listen to and, hopefully, incorporate that feedback.

As we have seen, the Parliamentary and Health Service Ombudsman, alongside the CQC, supports individuals to raise complaints against the private sector, the NHS and all public health authorities.

The point I am trying to make is that there appears to be a plethora of services and public bodies that work to oversee the function of the Mental Health Act and try to ensure that patients have a voice in their care and treatment. While I appreciate that some of the proposed duties of the commissioner would be unique to that role, there appear to be elements of duplication in that role and those of existing public bodies. However, I am also conscious of the point made by the noble Baroness, Lady Tyler, about being complementary.

So, while I hear the arguments on both sides, I am still slightly sceptical about whether we need a stand-alone mental health commissioner. To be fair, we have not completely made up our minds yet, and my noble friend Lord Howe and I are weighing up the arguments. For that reason, I ask the Minister to help these deliberations by clarifying a few points. First, will she confirm whether the CQC will take on the role of implementing the provisions of the Bill? Perhaps more importantly, how will it be able to fulfil that function effectively, given the concerns expressed by the noble Baroness, Lady Tyler, the noble Lord, Lord Bradley, and others and their strong feeling in favour of an independent mental health commissioner?

What action will the Department of Health and Social Care take to ensure oversight of the CQC’s role in the implementation of this legislation? If the Government remain opposed to the creation of a commissioner, can the Minister reassure your Lordships on how existing bodies will address the Bill’s implementation and accountability for its implementation, without the need for a stand-alone mental health commissioner?

I hope the Minister is able to give these assurances. Otherwise, given what was said today by other noble Lords, I am sure we will come back to this issue on Report.

[Baroness Merron (Lab)]

My Lords, I am grateful to the noble Baroness, Lady Tyler, for tabling Amendment 131, supported by the noble Baronesses, Lady Bennett and Lady Murphy, and my noble friend Lord Bradley. As noble Lords are aware, I understand the intent behind the amendment. We have carefully considered the proposed functions of the commissioner that it outlines, and we recognise that improvements are needed to ensure that the system works effectively. But as noble Lords are aware, we do not feel that a new body is the answer. As the noble Lord, Lord Kamall, said, it may only duplicate existing functions, rather than providing the clarity and leadership that I know everyone is seeking. I was particularly interested to hear the noble Lord give his reflections on the opinions of the previous Government about a proposed mental health commissioner.

Overseeing implementation of the reforms is the role of the Department of Health and Social Care, working with NHS England, the Ministry of Justice and the CQC in England, and, in Wales, with the Healthcare Inspectorate Wales.

On the interaction between this legislation and the Mental Capacity Act, we are committed to keeping that under close review to minimise challenges potentially faced by front-line professionals.

The annual report by the commissioner proposed in the amendment would overlap with the CQC’s annual Monitoring the Mental Health Act report. The CQC’s annual statutory reporting reflects the views of thousands of patients interviewed each year by the CQC. Many of the issues that the commissioner would assess and report on, such as the accessibility of advice and the quality of services, are already reported on by the CQC.

It is proposed that the commissioner would examine cases of people detained under the Act. This clearly overlaps with the functions of the CQC and Healthcare Inspectorate Wales, which have a statutory duty to monitor and, where appropriate, to investigate. The Act provides the regulator with similar powers—for example, to gather information to support it in exercising these powers.

The Health Services Safety Investigations Body is responsible for conducting independent investigations into patient safety concerns across England to identify ways to improve mental health care and patient safety. It has just concluded a series of investigations into in-patient mental health care and is currently undertaking further work.

With regard to the proposed commissioner’s general powers, it is the Government’s role, with NHS England, to ensure sufficient capacity and resources in the system. It is the role of NHSE’s national director for mental health and the medical director for mental health and neurodiversity, newly established last year, to oversee and take forward improvements to mental health services. It is already the role of the regulator to safeguard the rights and welfare of patients, while other organisations independently investigate complaints.

Minimising duplication with these organisations and functions would require significant remodelling of the system, interrupting ongoing programmes and responsibilities that are important to the smooth delivery of the Mental Health Act reforms. Having said that, we recognise that improvements need to be made in the quality of care and the patient safety landscape. We are committed to that goal and intend to overhaul the healthcare system to make it better for all patients.

The CQC has already begun to implement the recommendations made by Dr Penny Dash and Professor Sir Mike Richards: a new chief inspector for mental health will use their independent voice to amplify and respond to the experiences and outcomes of people who use services. Implementation of Mental Health Act reform will be at the top of their “to do” list.

On the wider landscape, we expect to hear soon from Dr Dash who, as noble Lords have said, is reviewing the broad range of organisations that impact on quality and safety, many of which I have mentioned today, and is due to report on whether greater value could be achieved through a different delivery model.

Reference was made in the debate to the role of the Children’s Commissioner, which the noble Baroness, Lady Tyler, particularly focused on. I want to place on record my gratitude to the Children’s Commissioner for the work done on children’s mental health. But, in reflecting on the debate earlier, I should say that the Children’s Commissioner is operating in a rather difference landscape. The proposed mental health commissioner would have a much narrower purview that, for the reasons I have stated, risks overlapping with existing organisations in a way that the Children’s Commissioner does not. I understand why the Children’s Commissioner is being looked to, but I cannot draw that direct comparison myself.

The challenges we have heard about in this debate have highlighted areas we need further to focus our efforts on. I look forward to speaking to the noble Baroness, Lady Tyler, about this topic this week, and I am sure that I will have further conversations about it. For all these reasons, I ask the noble Baroness to withdraw Amendment 131.

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[Baroness Butler-Sloss (CB)]

My Lords, I remember a specific case of a friend’s 17 year-old daughter who was suffering from an eating disorder. She had to go into hospital, where she was not treated at all well; she was criticised for not eating—the very thing she had gone into hospital to get help for. She did not for quite some time get any specialised help on how to deal with her eating disorder. This amendment would deal with that issue.

[Lord Kamall (Con)]

My Lords, I thank the noble Baroness, Lady Parminter, for moving this amendment. Unlike in the last group of amendments, where there was limited support, we fully support her on this one. We know that the noble Baroness has tirelessly campaigned for better support for those with eating disorders. At Second Reading, she shared the experience of living with such disorders, and we all became much more familiar with some of the concerns. I also agree with my noble friend Lady Browning that it is about time we stopped treating all people with mental ill-health the same; we know that we have to look at it in far more granular detail.

The amendment speaks to the problems around the adequacy of provision of care for patients suffering with eating disorders. As the noble Baroness said, Section 140 of the Mental Health Act provides for reception of patients in cases of special emergency and the provision of accommodation and facilities suitable for under-18s, but it applies only to hospitals. I agree that there is a reasonable case to extend this to specialist eating disorder units. With that in mind, I hope the Minister will be receptive to this amendment.

[Baroness Merron (Lab)]

My Lords, I am grateful to the noble Baroness, Lady Parminter, for bringing Amendment 132 to your Lordships’ Committee, for raising this important issue, for sharing at Second Reading, as the noble Lord, Lord Kamall, said, her personal experience of her daughter’s treatment and for sharing her overall experience of the provision of services today. The noble Baroness, Lady Browning, made the important point about different conditions needing different provision and support. That was amplified by the noble and learned Baroness, Lady Butler-Sloss, and the noble Lord.

Eating disorders are of course serious mental health challenges, and it is vital that those with them can access effective help quickly. We will continue to work closely with NHS England to improve access to the right and timely care and treatment for those with an eating disorder.

The purpose of Section 140 is to ensure that approved mental health professionals are aware of the services available to help them to locate hospital beds in special cases. The intention of the amendment is to extend the duty on health authorities to notify local authorities of arrangements for urgent cases and under-18s to include specialist eating disorder units.

Section 140 applies to arrangements for people who need in-patient treatment in a hospital. That includes specialist eating disorder units where they provide in-patient treatment in a hospital setting and are appropriate for someone to be detained in. Therefore, while I understand the points being made, it is not necessary to specify that Section 140 applies to specialist eating disorder units. I hope the noble Baroness will feel able to withdraw her amendment.

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[Baroness Hollins (CB)]

Can I just say that I did not talk about a “care pathway”? Perhaps I should have said the “patient journey”, but I was talking about the patient pathway—the actual experience of the person—which is not separated in their life.

[Lord Kamall (Con)]

My Lords, I will be brief on this one. I thank the noble Baroness, Lady Tyler, for this amendment and thank all noble Lords, who made very valid points.

Clearly, this is another sensible proposal, highlighting as it does the importance of making sure that the ICBs commission sufficient mental health services in the community to meet the demand for them. As the noble Baroness, Lady Barker, said, where will people go in the middle of the night? I know that we will come back to some of these issues when we discuss the group on mental well-being but I thought it was important that those points were raised now.

The Committee may remember that this was the subject of Amendment 139 in the name of my noble friend Lord Howe, who spoke to it on the second day in Committee. The main difference between those amendments is, I think, that the noble Baroness, Lady Tyler, wishes to get ICBs focused on this very important task as soon as the Bill becomes law—and I agree with her intention on that. My only fear around the wording as it is currently drafted—I recognise that it is a probing amendment—is that

“insofar as is reasonably practical”

may provide an excuse, or, as we say, the proverbial long grass into which this duty could be conveniently kicked. I look forward to the Minister’s response.

[Baroness Merron (Lab)]

My Lords, I thank noble Lords for their contributions on both these amendments. I turn first to Amendment 134 in the name of the noble Baroness, Lady Tyler, and spoken to by my noble friend Lady Ramsey and the noble Baroness, Lady Barker, both of whom shared real-life examples to illustrate what is being spoken about here.

This duty to consider mental health needs, as well as the needs of those with a learning disability and autistic people, in the community as well as in hospital is already covered by ICBs under the National Health Service Act 2006, as amended by the Health and Care Act 2022. An ICB 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 mental health trusts are also required to prepare a joint forward plan that describes how the ICB will arrange for NHS services to meet its population’s physical and mental health needs, and the needs of those with a learning disability and autistic people.

On the general point with regard to the long-term workforce plan, which the noble Baroness, Lady Barker, mentioned, it will report in a few months’ time, later in the year, which I hope will give a lot more substance to answer the kinds of questions that are being raised. The noble Lord, Lord Stevens, asked about incremental requirements for psychiatrists on a year-by-year and whole-time-equivalent basis. I say to the noble Lord that the impact assessment sets out our best estimate at this point, but the plans need to be seen as somewhat iterative. With regard to further specific questions, including those raised by the noble Baroness, Lady Tyler, I will indeed be glad to write.

Turning now to Amendment 157, in the name of my noble friend Lord Davies and spoken to by the noble Lady Baroness, Lady Bennett, as we have already discussed in relation to Amendment 134, there is already a duty on ICBs to provide sufficient hospital and community services under the National Health Service Act 2006. Furthermore, chapter 16 of the Mental Health Act code of practice already states that local authorities, NHS commissioners, hospitals, police forces and ambulance services should have local partnership arrangements in place to deal with people experiencing crises in mental health.

We accept that there are issues with bed capacity and patient flow, as referred to by the noble Baroness, Lady Hollins. I will resist using the term “patient pathway”, but I certainly agree that they are part of what happens to a patient and they are indeed linked—whatever form of words we choose to use. That is why, in the recent NHS planning guidance, we have tasked local systems with reducing the length of stay in mental health wards and have committed £26 million to improve mental health crisis care, with a further £75 million to reduce inappropriate out-of-area placement. All this is already in train and does not suggest a requirement for primary legislation. So, for these reasons, I ask that the amendment be withdrawn.

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[Baroness Watkins of Tavistock (CB)]

My Lords, I very much support this amendment and do so for an additional reason to those already given, which is that it will reduce the time staff have to spend discussing debt with severely ill people in a time of crisis. One thing we need to do is improve productivity in the health service—I declare my interests in relation to that—and free up clinical staff to really support patients. I believe that this intervention would actually enable that.

[Lord Kamall (Con)]

My Lords, in speaking to this amendment, I pay tribute to the work of the noble Lord, Lord Davies, in raising this issue in this House and through his work with the Money and Mental Health Policy Institute. The noble Lord, Lord Davies, said he hoped that he would get my support; I can assure him of that. Today, and in previous groups of amendments related to advance choice documents, the noble Lord spoke powerfully about the need to understand the link between financial problems and mental health problems. It also reminded us that while this may not be seen as a priority for people detained under the Mental Health Act, it is not difficult to imagine why they might neglect their personal finances—obviously, not their first priority. During this time, their bills will not be paid, debts will grow, and this could lead to debt collectors or bailiffs being called in, making the situation far worse.

I was particularly struck by the personal testimony that the noble Lord, Lord Davies, read out, in the earlier group of amendments, from the person who was helped by the Money and Mental Health Policy Institute, about not being asked whether there was anyone who could open their mail and keep on top of their day-to-day living. For them, as the noble Lord told us, it was a spiral of going in for treatment and coming out to find that their finances were in a bigger mess than before. What would that do to someone who was suffering from mental health issues? It was a bigger mess, leading to terror, shame and guilt, and in fact it undid the work of the treatment that they originally went in for. Also, as the noble Baroness, Lady Bennett, has said, the phrase “breathing space” is very evocative of what we are asking for here.

It is worth repeating that this amendment does not require health and care professionals to offer financial advice. We are not asking them to be financial advisers or to deal with issues that they are not experts in. It is about empowering them to identify people in need and refer them to the appropriate existing support. As the noble Baroness said earlier, this will improve productivity and save all that time that would be wasted. It need not cost much money, or indeed any money in some cases, but could save the patient from financial and mental distress and save taxpayers’ money. For this reason, we are supportive of this amendment.

NHS: Electronic Patient Record Systems

Lord Kamall Excerpts

Wednesday 12th February 2025 Lords Chamber

Asked by

[Lord Kamall]

To ask His Majesty’s Government what plans they have made to complete the rollout of electronic patient record systems to NHS trusts which have not yet implemented them.

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

My Lords, NHS England has supported over 160 trusts with digital transformation, including the implementation of electronic patient records. Currently, 91% rollout of electronic patient records has been achieved, with work under way to provide tailored support to the remaining 19 trusts that do not yet have an electronic patient record.

[Lord Kamall (Con)]

I thank the Minister for that informative Answer. As she will know, the rollout of electronic patient records is just the first step towards full digital maturity, which will allow systems to share data across the system, not only for patient care but for research data that can help with preventive care. Can the Minister tell us more about what specific, targeted assistance those trusts that have not yet reached digital maturity are being given to ensure that they are digitally mature, whether they have the technology but are not yet using it to full capability or they need better technology to achieve full EPRs?

[Baroness Merron (Lab)]

I first acknowledge the role that the noble Lord, and the noble Lord, Lord Markham, played when they were Health Ministers. They both drove this agenda forward. I am grateful for that. The tailored support includes a number of activities to install, upgrade and optimise electronic patient records to meet the standard that the noble Lord is aware that we need to meet. I am sure that he is aware of the What Good Looks Like digital framework. That is an assessment of how digitally mature a system is. It gives guidance but also highlights where intervention must take place to bring it up to the right standard, which we would all want to see.

Health Research

Lord Kamall Excerpts

Wednesday 12th February 2025 Lords Chamber

[Baroness Merron (Lab)]

Our commitment in this country to supporting humanitarian aid and development across the world, including in this area, remains steadfast. It will not be affected by any external decisions. With respect to the US decision to pause foreign aid funding for three months pending a review, as I have said previously, this is a matter for the United States. We note that decision, but the experience of the Covid pandemic is writ large and shows us that disease respects no borders, so it is in the interest of all of us to do the kind of work the UK did, for example in developing vaccines at that time.

[Lord Kamall (Con)]

Can I take this opportunity to ask a question about the UK’s wider health research ecosystem? The Government have talked a lot about moving towards prevention. How is this translated across to the health research environment? And while it is right that we look at cures and get better cures, given that testing and diagnosis are an important part of prevention, have the Government thought how we could focus our research on ensuring that simple tests such as blood tests or breath tests can detect more conditions and diseases earlier—for example, cancers including less survivable cancers?

[Baroness Merron (Lab)]

Yes, very much so, because it is by doing so that we will improve prevention and make the move from sickness to prevention. I can tell your Lordships’ House that the Government are continuing to support commercial clinical research delivery, including through new NIHR commercial research delivery centres that work with industry and other research infrastructure. I was pleased to visit one of them in Leicester, meet patients and hear how they were very engaged in doing exactly what the noble Lord is referring to.