Musculoskeletal Health

Lord Kamall Excerpts

Thursday 30th January 2025 Lords Chamber

[Baroness Merron (Lab)]

My noble friend raises a very important point from a position of a lot of experience. I can confirm that we recognise the importance of regular physical activity for those with MSK conditions. It helps to reduce pain and disability as well as improving well-being and helping with other conditions. The existence of MSK hubs with a non-healthcare workforce delivering physical activity-based interventions has been extremely helpful, and we will continue to encourage that and explore the role that hubs can play.

[Lord Kamall (Con)]

My Lords, we should pay tribute to my noble friend Lord Black for all his hard work in this area. I do not think the Minister answered his Question. On Tuesday evening she told the House she wanted to be honest, so in that spirit can she tell your Lordships whether the Government have agreed new dates, first, to begin the rollout and, secondly, to achieve universal fracture liaison services? If so, what are those dates? If not, can she tell us when we will have those dates, so that all the people waiting for these services are clearer about what they can look forward to?

[Baroness Merron (Lab)]

I am afraid I cannot give the noble Lord the dates that he seeks, but I will be pleased to keep him updated on the development of services.

New Hospital Programme Review

Lord Kamall Excerpts

Tuesday 28th January 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, when we have Statements such as this, it is easy to fall into the old-fashioned debate of the Opposition condemning the Government for every change to policy that they announce, and the current Government blaming the previous Government. I hope that the Minister will appreciate that, as the shadow Health Minister, I have tried to act in a more constructive manner—I see her nod—by supporting the Government when we agree, and by asking questions to understand their reasoning and ambitions.

We all want a system of health and care that is fit for the future, fit for today and patient-focused. We welcome the Government’s focus on their three principles. I shall not test the Minister on them, because I know that she can reel them off. They are: hospital to community, analogue to digital and sickness to prevention. Indeed, when I was a Minister in the department, part of my job was to push the digital agenda in health and care.

With that, I am equally sure the Minister also welcomed the opening in April last year of the new Dyson Cancer Centre in Bath, as well as the completion of the Greater Manchester Major Trauma Hospital in May 2024. We are disappointed that the Government have delayed the new hospital programme, and it was also disappointing to see the Secretary of State criticising some of the aspects of the new hospital programme.

We completely understand that the Government have felt it necessary to reassess the timeline for delivering the hospital building programme, but may I press the Minister on those changes? Having delayed some of these new hospitals and the rebuilding of existing hospitals, are the Government still committed to building the same hospitals on the same sites? Is there a possibility that they will change the criteria for where the hospitals will be built?

We also want to understand how this fits into the Government’s other ambitions. The Government are committed to building 1.5 million new homes. Where these new houses are concentrated will inevitably create new areas of pressure on health and care services. Will the Government be considering the impact of their housebuilding targets on the location of these new hospitals, and will that affect the hospital programme?

I have one final point. Brand new, state-of-the-art, large-scale hospitals are all well and good, and we certainly need more hospital capacity, but I know the Minister will agree that they should be supplemented by an increase in primary care facilities. I know the Government have committed to doing just that. The noble Lord, Lord Darzi, was unequivocal in his support of this in his recent report. Have the Government allocated funding for new primary care centres, such as the one mentioned by the Minister in Oral Questions today, and community health and care centres that could offer some secondary care services, taking pressure off the hospitals, but also better rehabilitation for people in their local community, also taking pressure off the larger hospitals? I look forward to the Minister’s responses.

[Lord Scriven (LD)]

My Lords, I extend my gratitude to the Minister for the Statement on the pressing issue surrounding the new hospital programme review. This initiative, inherited from the previous Conservative Government, who overpromised and underfunded, was a significant letdown for countless communities and patients across England. While the ambition to modernise hospital infrastructure is commendable, the current trajectory raises serious concerns that demand urgent attention.

Such concern was raised in a recent email from the chief executive of Leeds Teaching Hospitals NHS Trust, which showed the impact on both patients and staff of such a delay for capital investment in the hospitals that he leads. Recent data paints a worrying picture: hospitals facing delays under the new hospital programme reported over 500 infrastructure-related incidents in the past year alone. These failures led to the loss of 32 days of clinical time, directly impacting patient care.

This is not just about numbers, it is about real people unable to recover, return to work or resume their daily lives because of these delays. Alarmingly, nearly 100 flooding events occurred in these hospitals that have now been delayed for repair and rebuilding, representing a quarter of all such incidents across NHS England, despite these hospitals accounting for less than 1% of the total NHS estate. Helen Morgan MP, the Liberal Democrat spokesperson in the other place, aptly described these hospitals as “hanging by a thread”. She rightly criticised postponement of essential projects as a “false economy” that jeopardises patient safety. Delays not only inflate cost, forcing hospitals to allocate more of their stretched budgets to essential maintenance, but allow estates to deteriorate further, leading to closed clinics and clinical facilities, extending waiting times and possibly leading to poorer health outcomes for patients.

Therefore, I ask the Minister: have the Government conducted an impact assessment of these delays? If so, will she release a comprehensive evaluation detailing the risk to patients’ well-being, the additional maintenance cost anticipated between now and 2039 for these hospitals, and the financial implications of delaying investment? Specifically, have the Government considered whether to adopt an invest-to-save model, offsetting the cost of borrowing against the escalating maintenance burden and the economic inactivity for some patients caused by estate failures? This could provide a more sustainable way of building these hospitals.

The Autumn Budget of 2024 announced a £3.1 billion increase in the health and social care capital budget over the next two years. While welcome, this figure falls far short of the £6.4 billion per year experts say is necessary to address the NHS’s growing challenge. Over recent years, the maintenance backlog has more than doubled in real terms, rising from £6.4 billion in 2015-16 to a staggering £13.8 billion in 2023-24. This includes urgent issues such as crumbling roofs, outdated electrical systems and failing heating and ventilation—conditions that no hospital staff or members of the public should endure.

The King’s Fund has highlighted a troubling practice. Despite planned increases in capital investment, financial pressures have driven the reallocation of capital budgets to cover day-to-day spending. This undermines the long- term investment urgently needed to maintain and upgrade our healthcare facilities. In light of these alarming facts, I pose the following questions to the Minister. What specific measures have been implemented to ensure that delays to hospital building programmes do not compromise patient safety? How do the Government plan to bridge the gap between the £3.1 billion and the £6.4 billion per year experts say is required to address the NHS hospital maintenance backlog? Will the Government publish a detailed impact assessment of the delayed projects, outlining the risk to patient care and safety? What strategies have been put in place to ring-fence capital budgets, ensuring they are not diverted to cover day-to-day expenses? How do the Government intend to address critical maintenance issues, such as failing roofs and outdated electrical systems in hospitals that will not see rebuilding until the mid to late 2030s?

In conclusion, while the Government’s commitment to improving hospital infrastructure is evident, the current capital allocations are insufficient to address the pressing needs of these facilities. Without sustained investment, the Government risk compromising both patient safety and quality of care. I urge the Government to reassess their funding priorities and consider an invest-to-save model to secure safe and effective hospital environments for patients and professional staff alike. I call on the Minister to address these concerns with the seriousness that they deserve.

Community Pharmacy Closures

Lord Kamall Excerpts

Tuesday 28th January 2025 Lords Chamber

[Baroness Merron (Lab)]

The noble Baroness raises a good point and work is continuing to resolve that. It might also be helpful to say that NHS England has commissioned an economic analysis of the cost of providing pharmaceutical services and that will inform future funding arrangements. I say that in answer to the point the noble Baroness made about the potential savings that can accrue if we maximise the role of pharmacies.

[Lord Kamall (Con)]

My Lords, I understand the point that the Minister made about large chains rationalising their portfolios of premises. Have the Government and the NHS looked into whether the extra money made available to pharmacies from the Pharmacy First programme can make these pharmacies viable where they would not have been before? Secondly, what conversations are NHS England and the department having with retailers, community hubs or, where feasible, GP surgeries to provide local community pharmacy services in partnership with them?

[Baroness Merron (Lab)]

The economic analysis by NHS England that I just referred to will be helpful in informing where we go next. I confess that I did not get all the detail of the noble Lord’s second point, so I will look at it in Hansard and I will be pleased to write to him.

Young Disabled People: Social Care Services

Lord Kamall Excerpts

Tuesday 28th January 2025 Lords Chamber

[Baroness Merron (Lab)]

I have direct experience of the value of charities such as Mencap, and I thank it and all the other third sector organisations involved. I agree with my noble friend about the need to incorporate all sectors. That is the only way that we will provide the right provision in a timely fashion.

[Lord Kamall (Con)]

My Lords, we know it is true not only for this care service but for many health and care services that there is often concern when, upon reaching adulthood, the patient has to move from paediatric care to adult services—we have had a number of debates on that in this House. Often, that can involve a change of medical staff, from a clinician or caseworker who knows the patient to someone who is a stranger, as it were. Can the Minister tell noble Lords what guidance there is for the clinician or the health worker looking after the child, as well as for the clinician who will be looking after the child when they are an adult, whereby they talk to each other to ensure as smooth a transition as possible?

[Baroness Merron (Lab)]

The transition assessment has to cover the whole range of provision, including healthcare, as the noble Lord rightly says. That is already embedded. I refer back to the point of my noble friend: it is indeed true that there are long waiting lists for transition assessments, which is far from ideal. This means that people are suffering from late planning and insufficient support, which we want to put right, no matter where the requirement comes from, whether it is in health, education or employment.

Mental Health Bill [HL]

Lord Kamall Excerpts

Committee stage
Monday 27th January 2025 Lords Chamber

[Lord Bradley (Lab)]

My Lords, my Amendments 128A and 163B concern the banning of prisons and police cells as places of safety. By way of background, in my report in 2009, which I have previously referenced, I recommended that discussions should immediately commence to identify suitable local mental health facilities as the places of safety, ensuring that police stations should no longer be used for this purpose at that time. That sat alongside the development of mental health and learning disabilities liaison and diversion teams based in police custody suites and the courts, particularly to support the police in dealing with people with these issues. There is now 100% geographical coverage of the country with those teams. A crucial further element was the development of what was called street triage, where mental health nurses sat alongside the police in emergency control rooms or in police vehicles around local communities, again to support and assist the police.

The recent policy, “right care, right place”, is rightly based on the same principles debated on Amendment 37B, moved by the noble Baroness, Lady May. Again, at that time there was growing concern that A&E departments were, and still are, a default position as places of safety, and therefore the need to develop alternative facilities, often located close to A&E departments, often called crisis care units, should be pursued. There is an agreed protocol with the police to hand over the patients for care and assessment to NHS staff in the way advocated now by Amendment 128B, which has already been debated and is a model that I believe should be replicated across the country.

My amendments today are an attempt to galvanise the Government into action to achieve that. Amendment 163B to Clause 53 would require that Clause 46 came into force no later than 12 months after the passing of the Act. Amendment 128A to Clause 46 would require that the Government must publish a report on how they would ensure effective implementation of that section within the timeframe specified. I am again concerned at the lack of clarity in the timeline for the implementation of provisions in this clause. The impact assessment currently does not show an estimated commencement date for the provision in Clause 46, stating instead:

“Departments are working together to ensure there are clear pathways and provision in place to safely enact these reforms and the timeline for implementation will depend on the conclusion of this work”.


Amendment 163B would require Clause 46 to come into force within 12 months of the passing of the Act.

Amendment 128A would require the Government, within six months of the passing of the Act, to publish a report assessing: how they will ensure effective provision of alternative places of safety with adequate capacity and distribution across geographical locations; the availability of remand to hospital under Section 36 of the Mental Health Act 1983; and any plans to extend the use of Section 36 of the Mental Health Act 1983 to magistrates’ courts. Such a report will be crucial to the successful implementation of Clause 46.

Further—and this replicates concerns already expressed in Committee—I am concerned about the lack of reliable data on the use of prisons as a place of safety. The impact assessment references this, noting that there is no

“reliable data on the number of people in prison as a place of safety”.

Without knowing how many people are being held in prison as a place of safety, it would be difficult to ensure adequate alternative provision is in place. This data should be recorded and made available to inform effective implementation of this clause. Perhaps the Minister in response might be able to assure us that this information will be made available to the Committee.

Taken together, the removal of police stations and prisons as places of safety can be successfully introduced in a timely way, which many organisations, such as the Centre for Mental Health—for which I am an ambassador—and the Prison Reform Trust, have a long advocated. I hope the Minister will agree.

[Lord Kamall (Con)]

My Lords, I welcome the amendments from the noble Lord, Lord Bradley. As usual, he has been very sensible and measured in the amendments he has tabled. As the noble Lord reminded us, he has been very patient on many of the measures he is proposing.

I will speak to Amendment 140, which is also in the name of my noble friend Lord Howe, and hopefully touch on some of the amendments from the noble Lord, Lord Bradley. On a positive note, I will say how much we welcome Clause 46 and its removal of police stations and prisons as places of safety under the Mental Health Act. I think that noble Lords across the Committee welcome that, and the Government are to be congratulated on it.

The Wessely review stated:

“Far and away the best way to improve the care and outcomes for those with the severest mental illnesses is to provide more and better alternatives to detention”.


It also remarked that, all too often, opportunities for early intervention were missed. The report noted that this means that the first contact a patient often has is with the police, rather than with a mental health professional. I know we have discussed this and the overall involvement of police a number of times in Committee. I am sure we may come back to this on Report, but all noble Lords are aware that this must be addressed. Clause 46 is therefore very important in implementing that recommendation from the Wessely review.

I want to focus on a sentence that comes after the recommendation in the Wessely report:

“That means that, where they do not currently exist, health-based places of safety will need to be commissioned”.


I think this goes to the heart of the issue the noble Lord, Lord Bradley, was talking about—implementation but also data. Amendment 140 attempts to probe the Government. It would require the Secretary of State to publish a report on alternative places of safety for patients who are liable to be detained, particularly focusing on community care. We need to know this; as the noble Lord, Lord Bradley, said, we need the data.

Noble Lords have raised many times that we know that everything is not going to be done overnight. We understand that. We know there is a 10-year timeframe. We want a better understanding of what will be delivered when. Some of it will be subject to spending reviews, but some of it will be delivered whatever the result of a spending review. It is all very well saying that police stations and prisons and cannot be used as places of safety—no disagreement there—but this will mean that patients have to be placed elsewhere. Clause 46(2)(a) states that a place of safety for an adult is

“any hospital the managers of which are willing temporarily to receive that person”.

So far, the Bill seems to say—the Minister may correct me—that the only place of safety is a hospital. If I have misunderstood, I am prepared to be corrected, but as all noble Lords will know, that is not always ideal. Capacity in hospitals is in short supply. What will happen if a place of safety is needed but there are no appropriate hospitals nearby that are willing to receive that person, for lack of available space or staff? That is why this amendment places a focus on community-based alternatives for places of safety. If we can shift some of the burden here away from hospitals and into the community, part of the problem might be alleviated.

On an earlier amendment, Amendment 151, the noble Baroness, Lady Bennett, said that we all know that capacity in the community is currently quite limited. The report required by my amendment would enable the Secretary of State and the Department for Health and Social Care to consider and create a plan to develop greater capacity in the community for this purpose. We understand that not everything can be delivered now, but we would like to see a plan so that we can understand the Government’s intentions, their own timeframe and how they intend to roll this out. The amendment once again aims to probe the Government on their implementation plan.

I thank the Minister for meeting my noble friend Lord Howe and me to discuss appropriate places of safety. In that meeting, the Minister mentioned the community crisis houses that the noble Lord, Lord Bradley, alluded to, and said that her department was investigating how these might be used as alternatives to hospital or, indeed, police stations. As Mind says on its website, crisis houses provide

“intensive, short-term support to help manage a mental health crisis in a residential setting, rather than in a hospital”.

They can vary; some may simply provide temporary overnight accommodation to ensure that those experiencing mental health crises have a safe space away from other areas of their life, while others may provide treatment as well. Many of these crisis houses are operated by voluntary and civil society organisations.

One of my great passions in politics is to champion the role of local community civil society groups, so that we do not always have to look to the state to provide all the solutions. I think that there is some real promise here, and the Government are to be congratulated on it, for the provision of community crisis houses to be expanded, so that they can act as health-based places of safety, as the Wessely review recommended.

The questions I have at this stage for the Minister are in the nature of a probing amendment. What progress has the department made in exploring these community crisis houses and, indeed, other community-based places of safety, as alternatives to police stations and prison cells? Can the Minister tell us, when the Government are implementing the provisions of Clause 46 and commissioning health-based places of safety, whether they will include discussions with local civil society organisations and charities about how best to implement them, perhaps in partnership? I am sure she will recognise that their expertise will be highly beneficial and that they often know their local community much better than officials do, whether those be national officials or sometimes even local government officials. I appreciate that the Minister will not necessarily have all the answers tonight but, if not, I look forward not only to her comments but to the letter that she will promise to write to us afterwards.

[Baroness Merron (Lab)]

My Lords, I thank my noble friend Lord Bradley for his contribution and for Amendments 128A and 163B. I also thank the noble Lord, Lord Kamall, for speaking to Amendment 140 in his name and that of the noble Earl, Lord Howe. We are committed to implementing these reforms as soon as is it safe and practical to do so. We will return to this matter on the next day in Committee.

As I have said before—I know that noble Lords have heard this—we are reluctant to commit to enacting single provisions or publishing single plans or reports at specific times, given their dependence on so many other developments, particularly spending reviews. Removing police stations and prisons as places of safety under Section 55, and removing police stations under Sections 135, 136 and 136A will, as noble Lords suggest, require making sure that viable alternatives and clear pathways into support are fully established and in place. Commencing by regulations enables the reforms to be enacted once this is the case.

I know that my noble friend Lord Bradley is aware of this, but I will repeat it in respect of these amendments. Officials from my department, the Ministry of Justice and the Home Office are working with health and justice partners across government to develop the necessary plans to ensure that sufficient resources and the right processes are in place, and to establish clear timelines for implementation.

--- Later in debate ---

[Lord Scriven (LD)]

My Lords, I will be very brief because of the time. As with the previous group of amendments from the noble Lord, Lord Bradley, we are very supportive of the intention to try to tease out of government what the implementation plans are. It is really important to understand that being supportive of Clause 47 does not necessarily mean that we believe it will come into implementation in a timely fashion.

By supporting the noble Lord’s amendments, we wish to tease out of government the exact timing and resources that have been allocated; the planning the Government will have to do in terms of the number of provisions that will be required to implement this clause; the gap between the number of those facilities in place and those needed; and the estimate the Government have of when they would seek to put those facilities in place.

As the noble Lord, Lord Bradley, said, the location of those facilities—where there are gaps geographically and where they need to be filled—is very important. It is important that the Government furnish the Committee with those details so that we can fully understand not just the intention of implementation but the scale of the implementation plan required for this clause.

[Lord Kamall (Con)]

My Lords, just like in the last group, I will speak to and support the amendments in the name of the noble Lord, Lord Bradley. They follow the amendments in the previous group.

These Benches welcome Clause 47—another positive move—which addresses the issues arising from the current situation. As the noble Lord, Lord Bradley, said, bail can be refused solely on the basis of a mental health condition where it might otherwise have been granted.

In simple terms, as the noble Lord, Lord Scriven, said, this amendment returns to the theme that he, and many other noble Lords, have pushed the Government on—and I like the words used by the noble Lord—to “tease out” the plan and timetable for implementation from the Government, since it requires the Secretary of State to prepare a report on how they plan to implement these changes within the time period proposed in Amendment 163C.

We have to remember that the impact assessment states, in regard to the changes to remand for a person’s own protection, that:

“Departments are working together to ensure there are clear pathways and provision in place to safely enact these reforms and the timeline for implementation will depend on the conclusion of this work”.


That has been manifested this evening with the presence of a Minister from the Department of Health and Social Care and a Minister from the Ministry of Justice. However, there is currently no set date for the commencement of Clause 46, so it is all contingent on internal departmental assessments. We all understand how government works—how long it takes for things to happen, to get write-round and to get support across government—so I gently suggest to the Minister that the 12-month implementation timeline would be a useful target for the Government to work towards. It could help them to answer some of the questions that many noble Lords have asked in Committee on the plans for, and stages of, implementation. That is not to force the Government to move faster than they want to go, but just for us to understand the various milestones along the way in developing what is in the Bill.

It would also be helpful if the Minister could set out how much progress has been made both in the Ministry of Justice and the Department of Health and Social Care on establishing the pathways and processes to enable these remand reforms to go forward. This is especially true since the impact assessment also states—this is quite an interesting point—that:

“We expect the number of people on remand solely for mental health reasons to be low and therefore health and justice costs relating to this change are likely to be negligible, and therefore have not been monetised”.


We understand the challenges that the Government are often talking about—they have to wait for spending reviews, et cetera—but the impact assessment states that the number of people affected will be low. Can the Minister say whether either his department or the Department of Health and Social Care know what that means and how many people that will be? Does he know how many will be impacted by this change? If he accepts what is in the impact assessment—that the costs will be negligible—this could be a quick win for the Government in relative terms, depending of course on what other processes he feels have to be put in place before they can deliver this. I hope that the Minister can be a bit more helpful on his noble friend’s amendments, given that the costs are low.

We look forward to the Minister’s response, and I would be grateful if he could give an indicative timeframe or an indication of when a timeframe will be in place.

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

My Lords, I am grateful to my noble friend Lord Bradley for bringing this discussion before the Committee. These amendments would require the Secretary of State to publish a report on the implementation of Clause 47 within six months of the date on which the Bill is passed and that the reform comes into force a maximum of 12 months after the date on which the Bill is passed.

We are committed to implementing our reform to the Bail Act as soon as is practicable and as soon it is safe to do so. However, before moving to amend the legislation to embed these changes, we will need to make sure that viable alternatives are properly established and clear pathways to the right support are in place, whether in hospital or in the community. Commencing by regulations enables the flexibility to implement the reform at whatever point the necessary alternatives and pathways are safely in place.

I reassure my noble friend Lord Bradley—just as the Minister, my noble friend Lady Merron, did in relation to the previous groups of amendments—that my officials are working with colleagues across government to develop this and to ensure that sufficient resources and processes are in place. This includes the work of the north-east health and justice hub, which seeks to improve the way that courts, health services and prisons work together at a local level to smooth pathways into care, alongside the pilot team collecting data. That will help us better to understand the number of people remanded for their own protection solely on mental health grounds to inform planning.

The reform is currently due to commence by regulation, so we have the flexibility to implement it at whatever point the necessary alternatives to the pathways are in place. The rollout of the bail information service will be completed by autumn this year. This will help the courts to have the information they need to make decisions on bail for this cohort. However, we need to make sure that we have the reliable data on the number of people remanded for their own protection, because if this is rushed, it could create knock-on impacts for health services.

Mental Health Bill [HL]

Lord Kamall Excerpts

Committee stage
Monday 27th January 2025 Lords Chamber

[Baroness Tyler of Enfield (LD)]

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

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

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

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

[Lord Kamall (Con)]

My Lords, I thank all noble Lords who spoke to the amendments. I also thank the Government for allowing the Minister for Prisons, Probation and Reducing Reoffending to reply to this group. That is very much welcomed by the Committee. I think it was the noble Lord’s father who once said, “Kindness is good for business”. In this case, he might find that kindness is good for his noble friend the Minister. Given how hard she has been working on the Bill, I think she deserves some respite, so I am sure that that is very welcome.

So far, we have debated the importance of limiting detentions for those with autism or learning disabilities without co-occurring mental disorders. We have also debated the community treatment orders. But until now, we have not covered the provisions of the Bill relating to this new statutory 28-day time-limited period for transfers from prisons to hospitals. As the noble Lord, Lord Bradley, has said, he has been very patient. Therefore, the Government enshrining this target in law is welcome. Unfortunately, progress towards the goal of 28 days, as set out in the 2021 guidance and the White Paper, has been slower than anticipated.

His Majesty’s Inspectorate of Prisons, in its 2024 report The Long Wait—I am sure the noble Lord is aware of this—said that

“people linger in prison for weeks, often months and even, in the worst cases, for more than a year waiting for their transfer to be completed”.

Unfortunately, even though the 28-day guidance was there from 2022-23, only 15% of patients in that period were transferred to hospital within that timeframe. Sadly, the average wait was 85 days, and one prisoner was identified as waiting 462 days for transfer to hospital.

These Benches welcome the 28-day limit being put on a statutory footing, but, as other noble Lords have said—not only on this group of amendments but on others—once again, there is an issue of implementation here. Just because it is in legislation does not mean it will deliver the improvements that are necessary.

The noble Lord’s colleague—the noble Baroness, Lady Merron—has been very candid with noble Lords, saying that not everything in the Bill will be delivered now, and that there is a 10-year timetable for implementation. Given that, will the Minister say, at this stage, whether the 28-day limit is an aspiration or something that could be delivered immediately? If, at this stage, it is an aspiration and—understandably so—awaiting future spending reviews, is he able to give an indicative timeframe? Is the hope for the next 12 months, the next five years or, perhaps, up to 10 years? That information would be very welcome to noble Lords. Many noble Lords have been asking this throughout this debate. We understand that not everything is going to be solved overnight, but it would be good if we could have as much information as possible on the Government’s intentions and aspirations, including indicative timetables, where they are possible. We also understand that not everything is going to be clearly tagged at this stage.

Another finding from the prison inspectorate’s report was that there were serious flaws with the data held on patients who were awaiting transfer. I understand that there is no publicly available data describing the access and waiting times for beds. The Minister might be able to correct me on that. Some of the data on the numbers of prisoners awaiting transfer obtained from providers had significant gaps, due to a lack of consistent and accurate reporting, and some data contained errors and unreliability. This might also impact on Amendments 97 and 98 from the noble Lord, Lord Stevens.

The noble Baroness, Lady Merron, may well tire of hearing me repeat the importance of collecting accurate and complete data, but, as I and many other noble Lords have said on many occasions, we really cannot solve many of the problems we face without data that is as accurate and timely as possible. Therefore, I urge both Ministers to take up the issue of data reporting for patients awaiting transfer from prison to hospital with their respective departments.

Turning to Amendment 96C in the name of the noble Lord, Lord Bradley, which creates an accountable person who will be appointed to oversee the transfer process and ensure that the statutory 28-day limit is completed, I think this, once again, speaks to the point of implementation. This could be a sensible way of holding providers to account and working with them to address the shortcomings in patient transfers. Given the Government’s 10-year timeframe for implementation, noble Lords have raised the importance of oversight and accountability. Therefore, in the remarks from the Minister and in any subsequent letter, I hope that the Government will be able to address the issue of implementation and to give an indicative timetable. I look forward to the Minister’s response.

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

My Lords, this is the first time that I have helped take a Bill through Committee, so I am grateful to noble Lords for bearing with me while I acquaint myself with the procedures. I appreciate the questions and suggestions from noble Lords because this is a subject that is very close to my heart, as someone who has recruited many of the people whom we are talking about, over many years. I have always thought it was very sad when colleagues whom I had recruited often had to leave because of their mental health problems and other complexities that they then found themselves in within the system.

Amendment 96, tabled by the noble Baroness, Lady Murphy, would remove the change to the detention criteria in Clause 34, provided for prisoners who become mentally disordered in prison and require transfer to hospital. This would mean that a physical hospital place must be identified before the detention criteria are met for transfer from prison to hospital under the Act. This differs from how “available” treatment is interpreted across the rest of the Act, and therefore risks delaying access to treatment. It would also affect the implementation of the statutory time limit in Clause 35, as the Secretary of State would not be able to issue a transfer warrant until a bed is identified, regardless of the patient’s needs.

Clause 34 aims to correct a divergence in the detention criteria, as opposed to creating one. I appreciate that the noble Baroness is seeking further clarity on how Clause 34 will operate and the intention of the wording. My officials would be happy to hold a teach-in with the noble Baroness on this. I therefore ask the noble Baroness to withdraw her amendment.

I turn to Amendments 96A to 96C, tabled by my noble friend Lord Bradley. We have known each other for nearly 10 years, six years after the important topic came on to his radar. Amendment 96A would place a legislative time limit on the referring body to issue a referral notice within two days of receiving a request for an initial medical report to assess whether an individual meets the criteria for transfer. The timing of the statutory referral notice being issued will not impact when the time limit begins. This starts from the day that the healthcare team requests the assessment, referred to in the Bill as “the initial request”. This amendment would therefore not benefit transfer timeliness. Additionally, placing a statutory time limit on the healthcare team in a detention setting to issue a referral notice would not be operationally viable, because not all services operate seven days a week. The current wording of “as soon as practicable” accounts for this and encourages the referral notice to be issued at the earliest point for each case.

Amendment 96B would place a duty on all relevant agencies to ensure, as opposed to “seek to ensure”, that the transfer is completed within 28 days. Due to the multiagency co-ordination required in the transfer process, there is no one body that could ensure punctual transfers. This is why we softened the duty, so that those in receipt of a referral notice must seek to ensure that the patient was transferred within 28 days. Having consulted with relevant agencies, we are confident that this is appropriate, given the complexities in the transfer process.

Amendment 96C, also mentioned by the noble Lords, Lord Kamall and Lord Bradley, would introduce a “specified accountable person”, appointed by the healthcare provider for the relevant place of detention, who would be responsible for ensuring that people are transferred within the 28-day time limit in Clause 35.

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Moved by

[Lord Kamall]

99: After Clause 37, insert the following new Clause—
“Duty to record patients not in the criminal justice system escorted to hospital by police(1) The Secretary of State must by regulations make provision to require the police and hospital trusts to record the number of patients who are not in the criminal justice system but are escorted to accident and emergency departments in hospitals by the police for treatment for mental disorder.(2) A statutory instrument containing regulations under this section may not be made unless a draft of the instrument has been laid before and approved by a resolution of each House of Parliament.”

[Lord Kamall (Con)]

My Lords, I beg to move Amendment 99 in my name and to speak to my further Amendment 137; both are also in the name of my noble friend Lord Howe.

Our Amendment 99 places a duty on the police and on hospital trusts to record the number of patients not in the criminal justice system who are escorted to accident and emergency departments by the police for treatment for a mental disorder. The reason behind this amendment is that a number of people are taken into accident and emergency by the police because they exhibit behaviour that is a cause for concern, resulting from a diagnosed, or even an undiagnosed, mental disorder or learning disability. These patients are not necessarily placed under arrest, since they may not have committed any crime, but they are escorted to hospital by police.

Once in A&E, it is quite common that they could wait for six, 12 or even more hours before they see a clinician. This is obviously not an efficient use of police time; I know that my noble friend Lady May spoke to this earlier in Committee. More importantly, a police officer escorting a patient who is demonstrating challenging behaviour could exacerbate the problem. Also, a patient who arrives with or without a police officer may behave in a way that is seen as threatening by other patients, which could lead to their being arrested, as they are seen as at risk of harming themselves or others. The patient then finds themselves in the criminal justice system.

To avoid situations such as this, we are probing the Government to try to understand how often the police take patients into hospital for treatment for a possible mental disorder when they are not under arrest. This data should help us to understand how much police time is being spent accompanying these patients. This is not to take a particular view one way or the other; rather, it is to say that we need to have this information available so that we can fully assess the situation.

Our Amendment 137 states that the Care Quality Commission

“must publish a report on the efficacy of systems designed to prevent the introduction of illegal drugs into mental health units”.

Hospitals are entitled to prohibit patients from misusing drugs or alcohol on their wards, but what they can do to enforce those requirements is less clear, especially with detained patients. We accept that informally admitted patients can be asked to leave by hospital managers or even escorted off-site by security if they do not abide by a hospital’s rules on illegal drug use. However, patients detained under the Mental Health Act cannot be forced off premises for violating these rules.

The risks of illegal drugs being used in mental health units are obvious and severe. There is a possibility of those drugs interfering with prescribed medication, which could make that medication ineffective or even harmful to a patient’s physical or mental health. Further risks include the effects—such as psychosis or aggravating effects—of certain drugs, which could potentially lead patients to become more violent and cause harm to themselves or to staff. Whatever the result, the use of illicit drugs in mental health hospitals does not contribute to the treatment or therapeutic benefit of patients; I suspect that is a British understatement.

Much of the information and literature on substance misuse in in-patient mental health settings seems to be out of date. The major studies that we looked at were conducted in the early 2000s; these included a paper published by the Psychiatric Bulletin in 2000. I am happy to be corrected if there is more up-to-date data, but it seems that we do not have enough adequate and up-to-date data available concerning the prevalence of illegal drugs in mental health units. Can the Minister tell us whether the department has up-to-date figures? If not, does it have any intention of collecting these figures? Once again, this would help us to understand the scale of the problem.

Whether or not we are fully aware of the prevalence of illegal drugs in mental health units, there must be adequate safeguards in place to ensure that their use is as limited as possible. This amendment probes the Government for some answers on how they are trying to achieve this. By requiring the CQC to publish an annual report on this matter, we hope that a fuller picture could emerge, which would, we hope, inform the development of procedures and processes to reduce the harms related to illicit drug use. I beg to move.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I shall speak to Amendment 151 in this group, which is in my name. It is a slightly diverse group, in that the noble Lord, Lord Kamall, has just set out his two amendments, which are very focused on specific areas, while mine is a very general one. However, they fall under the grouping as provided to us by the Whips; they are about monitoring and reporting, so there is some kind of sense here.

I start with the words of the noble Baroness, Lady Tyler, who in the previous group said that, without proper resources, this Bill is not going to work at all. That is what this amendment aims to address. I think the reason why it was regarded as within the scope of the Bill without any wrestling from me is that, specifically, the aim of this Bill is to have fewer people sectioned and fewer people under compulsory treatment orders. It aims to reshape and have earlier interventions, so that we do not see problems get so bad that we get to that point.

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[Baroness Merron (Lab)]

The noble Baroness makes a fair point, and that is something I shall return to later in Committee. I am keen, as I hope noble Lords know, to speak in your Lordships’ House about progress that is and is not made, and I will continue to do that.

Overall on this group, given the amount of plans and reporting already in place, we do not think that additional statutory review, particularly in relation to Amendment 151, is necessary. For all the reasons that I have put to the Committee, I hope noble Lords will be good enough not to press their amendments.

[Lord Kamall (Con)]

My Lords, I thank the Minister for her response and thank all noble Lords for their contributions to this group. I should have also mentioned that I am very sympathetic to the intention behind Amendment 151 from the noble Baroness, Lady Bennett. Noble Lords throughout this debate have been speaking about community resources and accountability for those resources; indeed, I have a related amendment in the seventh group. In some ways, the Minister has partly answered that probing amendment.

I am grateful to the noble Baroness, Lady Barker, and will reflect on the points she made. As the noble Baroness, Lady Tyler, said previously, this was a probing amendment to see what data was being collected. Noble Lords will understand that, if we want to improve a situation, we need to collect data. It may not be perfect, and perhaps we can have some conversations between now and Report about that. I am very grateful that the Minister said that this data is collected. I wonder if she could write to us with links to where it can be found. That could address some of the concerns raised by stakeholders who wrote to us, which led to this amendment being tabled.

I remember that, when I read the work of the pre-legislative scrutiny committee, the Metropolitan Police service’s submission said that, in 2021, for the first time more patients were conveyed to a health setting in a police vehicle than in an ambulance. I wonder if that is still true or if that situation has been reversed. The purpose of these amendments was to seek what data was available, so that we can address the problems that Amendment 99 and 137 sought to address. With those comments, I beg leave to withdraw the amendment.

Amendment 99 withdrawn.

Mental Health Bill [HL]

Lord Kamall Excerpts

Committee stage
Wednesday 22nd January 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, I thank all noble Lords who took part in the debate on this group. In responding to the Minister, I will touch briefly on some of the other amendments, but particularly on Amendment 57 in my name and that of my noble friend Lord Howe. I thank my noble friend Lady Browning and the noble Baroness, Lady Tyler, for adding their names to it.

On Amendment 61, I agree very much with the noble and learned Baroness, Lady Butler-Sloss, on the importance of parents and guardians, not only in respect of this amendment but all throughout the Bill and in the subsequent amendments that she tabled. It is very important that we do not forget that point and that we keep coming back to it.

On Amendment 58, in the names of the noble Baronesses, Lady Watkins, and my noble friend Lady Berridge, we are very sympathetic to the idea of extending this to under-18s. We have to reflect and may come back to this on Report.

The noble Lord, Lord Davies, and I were fortunate enough to have a conversation about his Amendment 59 during the dinner break. It is on a fundamental issue and we need to raise awareness of the link between finance and mental health. One can lead to the other: you might start off with financial difficulties and then find yourself with mental health issues, or mental health issues make it far more difficult to manage your finances. Frankly, when there are banks that do not necessarily understand the individual circumstances or are moving toward semi-automated decision-making, this is a whole minefield that we ought to tackle as soon as possible and not wait 20 years for the next mental health Bill.

On Amendment 62, in the name of the noble Baroness, Lady Tyler, continuity of care is absolutely important, and not just for mental health; I have been in debates in this House where it is really important for allergies or diabetes. When children are treated for a condition by children’s services they then worry, when they transfer to adult services, about whether they will continue to receive the same level of care, particularly if the clinician is different when they move over. They may well have had a very good relationship with that clinician as a child, but then they feel that they have to explain everything all over again, even though there are patient records.

Amendment 64, in the names of the noble Baroness, Lady Keeley, and my noble friend Lord Young, seems eminently sensible. It almost seems obvious; I was surprised that it does not happen at the moment. I take on board what the noble Baroness, Lady Keeley, said about previous attempts to put it into legislation; it must be fiendishly difficult.

One of the points that the Minister made was that young carers are entitled to some of the things that the noble Baroness was asking for. How do they know they are entitled to them? It is all very well to be entitled to them, but how do they know? This is true for physical health as well, but given it was raised on this specific issue, I would be interested in the Minister’s response. If she is not able to give that response, thanks to technology, over the airwaves to the iPad then perhaps she could include it in her letter to noble Lords afterwards.

The noble Baroness, Lady Barker, made an important point about Amendment 60A and housing. Housing, like finance, is one of those things that could lead to mental health issues, or having mental health issues makes housing much more difficult. The lack of adequate accommodation could lead to readmission, when we think about discharge afterwards, suitable accommodation and suitable circumstances.

I should be positive. I am grateful to the Government for the care and treatment plans in the first place. I think they are very sensible, which is why many noble Lords want them extended to not just that cohort of patients. I understand that sometimes we have to roll things out and learn from experience, and perhaps that can feed into future rollout—I understand sometimes not going for the big bang, as it were. On Amendment 57, I will read Hansard carefully and reflect on what the Minister said. I particularly thank her for the reference to the link to see what is being considered for inclusion in the care and treatment plan. I beg leave to withdraw my amendment.

Amendment 57 withdrawn.

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Finally, I note as a postscript that it is not only the understanding that the right reverend Prelate outlined. When one looks at training—obviously, we always talk about the training of healthcare professionals, et cetera—we see that, because a disproportionate number of people from ethnic minority communities are still within some kind of faith community, it is imperative that there is a heightened awareness of the need to train leaders, in those worshipping centres and other support groups, to recognise that many people repeatedly present as needing prayer in a Christian context. But they do not need prayer; they need to be told to go to their GP. For that reason, they often present later and they are often sicker by the time they present. Based on research I read a while ago, that is one of the reasons why in the black community there is later presentation; they are not accessing the services earlier. So can the Minister include in the focus of training that it is not just clinicians and those to whom the code of practice applies that need it?

[Lord Kamall (Con)]

My Lords, during the debates on this Bill—and throughout my time in this place—I have learned that there are specific topics about which other noble Lords are passionate. For example, the noble Baroness, Lady Hollins, who is not in her place for sad reasons, is passionate about many issues; but, in the context of this Bill, she has long championed issues around the detention of those with autism and learning disabilities, as has my noble friend Lady Browning. My noble friend Lady Berridge is very passionate about children and young people and about tackling racial discrimination, and the noble Lord, Lord Davies, is very passionate about the link between finance and mental health. Many noble Lords are passionate about specific issues. For me, Amendment 138, in my name and that of my noble friend Lord Howe, goes to the heart of an issue in which I very strongly believe, based on my own experiences of racism while growing up in Britain.

Before I go into that, I will touch on the amendments from by the noble Baroness, Lady Whitaker. In one of my first work experiences—in Chase Farm Hospital many years ago—I got to know and speak to a young patient from the Traveller community. He told me about the problems that the Traveller community had in getting access to medical care, and how members of the community were always treated with suspicion and not in the same way. So I am very sympathetic to those amendments.

To get back to my own experience, the Britain of recent years, which my children grew up in, is much less racist than the Britain that I grew up in the 1970s and 1980s, when it was common to be called offensive names or to be chased by skinheads, sometimes actually with weapons and knives. But my experience was a lot better than the racism that my father faced when he came here in the 1950s. There are horrendous stories that he told my siblings and me when I was younger. I believe that we can be proud of that progress, as a country and a society.

When I was a Member of the European Parliament, I used to chat to the taxi drivers in Belgium and France. I would tell them that I was from London, and not all of them but many of them would say how lucky I was, since they had a friend or relative in London and they thought that London was incredibly diverse and tolerant compared with where they lived. That was very touching to hear—but I have to admit that that is my experience, and some will have had different experiences. Even my experience does not mean that the battle against racism and racial disparities is over. As many noble Lords, including the noble Lord, Lord Davies, the right reverend Prelate and my noble friend Lady Berridge, have rightly said, we have to be vigilant on this.

As the noble Baroness, Lady Tyler, said, one reason for the review and this Bill is because my noble friend Lady May commissioned the Wessely review due to the disproportionate number of black people being issued with community treatment orders or being detained; noble Lords have referred to this. We have known about that issue for a long time. Although politicians in the other place and many noble Lords here have raised the issue many times over many years, we do not really seem to have grasped the issue or to be on top of it. When I ask colleagues and medical experts about the disparity, I get a variety of answers. In the absence of any widely distributed and comprehensive study, the vacuum is filled by anecdotes or assumptions, sometimes racial stereotypes. One of the most common responses I have heard is that it is complex or multifaceted.

I remember when I did not initially get into the local grammar school, despite having the best grades in the class—better than some of the white pupils who got into the school; it also happened the previous year, in the year above me, when one of my friends who was black, an Afro-Caribbean, topped his class and did not get into the local grammar school—and my mother challenged the decision and asked for the reason, she was told “It’s complicated”. Fortunately, she persisted, and I got my place thanks to the help of my local Member of Parliament, who later became the late Lord Graham of Edmonton, may he rest in peace.

So when I hear the response, “It’s complicated”, I hope noble Lords will understand that I am simply not satisfied with that answer. It is just not good enough any more. The purpose of my amendment is to probe the Government to understand what they know and what research they are aware of, so we can understand the reasons for these racial disparities and put in place measures to tackle them. If it is complicated, can the Government or NHS list the various reasons and say what they are going to do about it? As noble Lord after noble Lord has said, we need the data.

The noble Baroness, Lady Barker, who is not in her place, reminded noble Lords that many of the answers from the Minister sound similar to the responses from 20 years ago. That is not a political point. I suspect that the answers given by the Minister, who is well liked and respected, would not be very different from the answers prepared by officials for any Health Minister of any party. Some of the answers are probably very similar to answers that I gave when I was a Minister. That is not to disrespect the diligent civil servants in the department, who work really hard, but we need answers to the following questions.

What studies are the Government, DHSC and NHS aware of? What do we understand from the various studies? What secondary data do we have, and what are the known unknowns? What do we know that we need to know more about? Has there been any attempt from that secondary data to generate the questions for the primary research so that, once and for all, we can understand why a disproportionate number of black people are subject to community treatment orders and to being detained? Do the Government, DHSC or the NHS, if they have the data, know how to use it to reduce those disparities? If so, when will they begin to reduce these disparities?

I was very pleased to hear a reference to some of the pilot schemes. Perhaps the Minister can refer to some of those schemes, and maybe that would be helpful. But I have to say that if the answers that we receive to these questions, either tonight or when the Minster writes to noble Lords between now and Report, are not adequate, I suspect that noble Lords will have to send the Minister back to the department to kick the tyres and get a better answer. It is as simple as that; otherwise, I am afraid that we will return to this issue on Report. If it comes to that, I hope that we will not see a Government urging noble Lords from the governing party to vote against an amendment that would seek to tackle these huge racial disparities in a methodical way and with an evidence-led approach. I look forward to the Minister’s response.

[Baroness Merron (Lab)]

I thank noble Lords for the points they have made. I shall start with those from my noble friend Lady Whitaker regarding Amendments 63, 101, 107, 113, 116 and 124 and immediately address the point about the limited available data on Roma communities.

I absolutely acknowledge that the data on Gypsy, Roma and Traveller communities is indeed very limited. I emphasise that I say this not as an excuse; it is just what I have discovered. This is largely due to lower numbers, but we are working with NHSE to improve ethnicity reporting for all patients. More broadly, the Office for National Statistics is working with a range of government departments to undertake research into the barriers and enablers for this community in accessing a range of public services, including mental health services. Findings are expected later this year. I know my noble friend has been very active in pursuing this point and I am grateful to her for doing that. I hope that will be a generally helpful response.

I add to all noble Lords that I absolutely agree that information, communication and support should be provided in a culturally appropriate manner. However, we do not believe that the amendments would achieve that aim, nor are they necessary. The duty to take cultural differences into account in how services are delivered is already enshrined in the Equality Act 2010. These existing duties are the legal basis for ensuring that services are culturally appropriate. That said, we absolutely acknowledge that, in practice, many services still fall short, but that is the position that we find ourselves having to tackle. This is where we need to strengthen guidance. The patient and carer race equality framework is already in place to strengthen the application of these principles, and we will strengthen guidance in the code to ensure that duties under the Equality Act are embedded in practice. We therefore believe that these amendments would not have any additional benefit above what is already in place and what is planned.

On Amendment 65, tabled by the noble Baroness, Lady Tyler, we recognise that there are very significant disparities in the use of community treatment orders between different groups. This data is published as part of the annual Mental Health Act statistics. As the noble Baroness said, in 2023-24 it certainly was the case that patients from black and black British ethnic groups were around seven times more likely to be placed under a CTO than those from white groups. I add that patients from all minority ethnic groups are more likely to be subject to the use of a community treatment order than patients who are white. These disparities are explored in the impact assessment.

The noble Lord, Lord Kamall, drew on his personal experience, for which I thank him. I am sorry that he has to bring that personal experience here, but of course it is the case that the battle against racism and racial disparities is far from over—I completely agree. I am sure he will have noted the commitments made by this Government to tackle racism and racial inequalities, particularly in the NHS and social care.

The reality is—many noble Lords have spoken about this—that we are in a position where we have less data on outcomes and patient experience of being subject to community treatment orders. Officials are now working with NHS England and system partners to understand what additional data it would be wise and helpful to collect. We will cover CTOs in the planned independent evaluation of the reforms but, as ever, I have to share, in honesty, that it will take time to gather new data. A review after 12 months would be premature, not least because it would mean it was based on data from before any reforms commenced. I do not feel that that would be helpful. I assure noble Lords that, rather than committing in legislation to a review at a fixed date, we are committed to keeping existing and additional future data under review.

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[Lord Scriven (LD)]

I am grateful to the noble Baroness for giving way and sorry for interrupting her flow again. The point about having a staging report after two years is to get ahead and upstream of what is happening rather than retrospectively being able to do stuff after it has gone on. Two years in management terms to be able to determine trends of intended or unintended consequences and then put different things in place is really important. I believe that this amendment, with a report back to Parliament, would send a very strong signal and allow the Government, the department and NHS England to pick up trends, even if it was not the total picture, which would determine different policies and practices and potential changes in the code as well as management action. I think that is what lies behind the noble Lord’s amendment.

[Lord Kamall (Con)]

I am sorry to interrupt at this time. I note that the noble Baroness thinks that 12 months is too short, and many noble Lords can perhaps see the point that two years is too short. Does the department have any idea of what a reasonable timeframe is? There has to be some accountability, as the noble Lord, Lord Scriven, said. We could accept the warm words and the intentions of the Minister here tonight, but what happens if nothing changes? Where is the accountability? Can the Minister think about asking the department whether there is a reasonable timeframe for some meaningful research? I have supervised academic theses over time. You can have the one-year and then you go on to the three-year for PhD, and sometimes that is quite comprehensive data. There might be a meta study that could be done of lots of existing studies. First, what is a reasonable time? The noble Baroness does not have to answer now; it can be in writing. Secondly, if we let this go, how do we make sure there is accountability? How do we come back to this in three years or four years or five years? I look forward to the answer.

[Baroness Merron (Lab)]

I was about to say that I do understand the need for pace, but I know that noble Lords understand the need to get this right and I know they are not suggesting that we should get it wrong. I will certainly be glad to look at the points that have been raised. I assure noble Lords that I do not want this to be warm words and I understand what noble Lords are seeking. I want to ensure that it is right and that the pace is right. I will look at the points raised because—although I do not think anyone is accusing me of this—it is the exact opposite of avoiding accountability and transparency; it is just about dealing about what is in the amendments.

The noble Lord, Lord Kamall, asked me a number of very pertinent questions and to do justice to them I will write to him. In conclusion, I hope that noble Lords—

Mental Health Bill [HL]

Lord Kamall Excerpts

Committee stage
Wednesday 22nd January 2025 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I thank the noble Baroness for that response. One thing we can all agree on from this discussion is that these are complex issues and people sometimes have rather different understandings of what certain things might say or mean.

Having said that, I would just like to say where I think we are on the two issues. First, on advanced decisions, I have a strong view that children and young people aged 16 and 17 should have choices that are made available to adults extended to them. As I think the noble Baroness, Lady Bennett, said, it is about having a sense of agency and autonomy and feeling that their wishes and feelings are being respected. It may be that I did not draft it very well, but I was not suggesting that everyone was going to be forced to do it. It is there as an option, and that is a really important point that possibly did not come out sufficiently in the debate. The fault for that is mine. It may be that the approach that the noble Earl, Lord Howe, was suggesting is a better way forward. I do not know; I do not mind. I just feel that, because to me this is so fundamental and a question of human rights, we will need to return to this on Report.

I turn with some trepidation now to the statutory competence test for under-16s. I have been accused of being too cautious. That is fine. I understand where noble Lords were coming from. I did not say it when I introduced it, because I thought it would be a bit to odd to say it, but I was seeing my amendment as a bit of a backstop. In other words, if the Government are not minded to accept that recommendation, at least something would happen and at least there would be some sort of progress. As I said, I was very sympathetic to the test and the way that the noble Lord, Lord Meston, set it out. It had a fair amount of support, of course, across the Chamber, but the debate also showed that there are still some quite tricky issues that need to be teased out. I do not think it was quite as clear-cut as perhaps was being suggested, not least about issues around the consistency or otherwise of the application of Gillick.

It may be that, again, I did not get the wording right when I talked about a “review”. I accept that. Reviews can be kicked into the long grass and you never see anything again. But I thought the idea of a consultation was very important and, in fact, I think it would be quite difficult, having listened to this debate carefully, to move straight to having something in the Bill without having some sort of consultation first. It might be that you would want to take some sort of powers that would enable such a thing to be put in place after that consultation had happened, but to me it just felt that some issues still needed to be teased out.

Perhaps my initial amendment was not completely ludicrous, but it has been a really good and interesting debate—

[Lord Kamall (Con)]

Probing.

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Moved by

[Lord Kamall]

57: Clause 20, page 29, line 2, at end insert—
“(ba) is a patient who has been informally admitted to a mental health unit in accordance with section 131, or”Member’s explanatory statement
This amendment would ensure that patients who are admitted informally to a mental health unit will also benefit from a care and treatment plan.

[Lord Kamall (Con)]

My Lords, Amendment 57 stands in my name and that of my noble friend Lord Howe. The amendment is an attempt to ensure that patients who are admitted informally to hospital for a mental health disorder are also able to benefit from a care and treatment plan. As noble Lords will be aware, the Bill introduces statutory care and treatment plans but, as drafted, extends that right only to a select group of patients. As per the new Section 130ZA(2) of the Mental Health Act, patients who will be eligible for these plans are those who are formally detained under that Act, those who are subject to guardianship under the Act and those who are under a CTO.

I do not think there is any disagreement that these patients rightly deserve access to a care and treatment plan. But what about informal patients who voluntarily admit themselves for treatment? The Explanatory Notes explain that the purpose of putting these plans on a statutory footing is

“to ensure that all relevant patients have a clear and personalised strategy in place describing what is needed to progress them towards recovery”.

They also detail some of the possible inclusions in that care and treatment plan.

I note, however, that the exact inclusions in the care and treatment plan are to be made by the Secretary of State by regulations at a later date, possibly due to consultation. So, although we may have some idea of what might be included, it would be helpful if the Minister could confirm to your Lordships what the Government envisage will be included or could be included. I am not wanting to put the noble Baroness too much on the spot here.

As many noble Lords might well know, care and treatment plans have been part of the package of mental health treatment in Wales since June 2012 under Section 18 of the Mental Health (Wales) Measure 2010. Those regulations specify that the areas that must be included in the patient’s care and treatment plan include

“finance and money … accommodation … personal care and physical well-being … education and training … work and occupation … parenting or caring relationships … social, cultural or spiritual … medical and other forms of treatment including psychological interventions”.

Can the Minister confirm whether the care and treatment plans in England will follow the same format or possibly be inspired by the same format? Will there be differences? Are there England-specific issues?

I hope the Minister will understand that I have a few more questions. How will the Secretary of State decide what to prescribe in these plans? What level of consultation will there be? Indeed, what level of consultation has there been to date to inform this, particularly with the clinicians who will be responsible for drawing up the care and treatment plans?

One of the things that many noble Lords have discussed during this debate is the fact that we want to see evidence-led practices. We know that, particularly in mental health but also in physical health, these can help to inform care and treatment plans that have a positive impact on clinical outcomes and therapeutic benefit, because they are based on treatments unique to the patient’s needs.

A meta study in 2023 in the United States found that evidence-based practices

“improve patient outcomes and yield a positive return on investment for hospitals and healthcare systems”.

I note the Minister has referred a number of times to the Government making and implementing these changes when resources allow.

The Social Care Institute for Excellence has also highlighted the importance of person-centred care, writing:

“Research on mental health and wellbeing demonstrates that involvement leads to improved service outcomes and enhances mental wellbeing”.


The institute argues forcefully that care plans for mental health patients should include active involvement from the patient. It is therefore vital that care and treatment plans are not developed in a silo; they should be developed in conjunction with the patient. Given the benefits that access to care and treatment plans should bring patients with a mental disorder, it would be more than appropriate for informal patients to be included as well.

If anyone actually listened to what I said in the debate on our second day in Committee, they may be aware that I had some sympathy with the point made by the noble Baroness, Lady Murphy, who is not in her place. She argued that she did not want to extend the independent mental health advocates to informal patients, possibly because of resource constraints but also because of limited evidence on their therapeutic benefit. I could be accused of being inconsistent, but I would say that, for care and treatment plans, the issue is rather different.

The clinicians will draw up these plans. The Bill states that it is the “appropriate practitioner” who will already be treating that patient, so it may not be the same issue of resources. Perhaps it will take extra time, and I understand that time adds up the more you require of a clinician. But, given that the informally admitted patient will already be being treated by a clinician, we would not necessarily be adding much resource or burden on to the clinician, in the same way as if we had extended the IMHAs, as in the argument made the other night.

Therefore, I hope this amendment will extend provisions that will benefit informally admitted patients, as they will benefit the patients already decided upon in the Bill. I beg to move.

[Baroness Browning (Con)]

My Lords, I have added my name to this amendment. I will not detain the Committee long, but I support the amendment and I want to flag the point my noble friend made about Wales and England. To my certain knowledge, when people living further north around the Shropshire border, for example, are admitted, they will almost certainly be offered placements in north Wales. It is important that there is some harmony in these regions; otherwise, it will cause additional problems. I hope my noble friend will press his amendment in due course to make sure that that harmony exists.

Health and Social Care: Winter Update

Lord Kamall Excerpts

Tuesday 21st January 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, when this Statement was given in the other place last Wednesday, the situation in the NHS had deteriorated: the weekly influenza hospital admission rate for the last week of 2024 increased to 14 per 100,000, with almost 11 per 100,000 being the figure for the previous week. Thankfully, I can see that the rates for influenza admissions are falling: the admission rate for the second week of this year fell to 9.5 per 100,000, compared to more than 13 per 100,000 the previous week.

While this fall in admissions is welcome, may I ask the Minister about the latest advice the Government have received? Do they believe that we are out of the winter woods yet, or are they being warned about the possibility of admission rates for seasonal respiratory viruses rising again, and the need to remain vigilant? Also, do the Government have any indication of whether this improvement is temporary, or whether things will get worse again? If they are planning for a possible rise in admission rates, what plans do they have to put in place sufficient capacity to meet an increase in the number of patients? What options are the Government looking at? For example, are they having conversations with the independent sector on the use of some of its hospital capacity?

One of the solutions, surely, to the winter pressures that successive Governments experience is better and faster data reporting. It can often take several weeks for data from hospitals and the front line to filter through to statistical reports. The problem is that there are data time lags, which means that the NHS has less information ready to figure out the gaps in performance and capability. If the NHS is adequately to plan to alleviate pressures, live data reporting must be a priority.

May I therefore ask the Minister first to commit to pushing forward implementation of faster and more efficient data collection with her departmental colleagues, in order to ensure reporting to help better plan for future winters? In that vein, how confident are the Government that they will learn the lessons from this year’s winter crisis and ensure that they are better prepared for next winter, in order to deliver on their promise to end the cycle of winter crises in the NHS? I look forward to the Minister’s response.

Mental Health Bill [HL]

Lord Kamall Excerpts

Committee stage
Monday 20th January 2025 Lords Chamber

We hear stories about autistic people and people with a learning disability being stuck on wards for an average of nearly five years, where they face being overmedicalised and institutionalised, sometimes to the extent that they can barely get out of bed. These detentions lead to severe lifelong trauma, which can be incredibly difficult to overcome. This leads to an obvious risk of readmission after they are discharged into the community. I feel this is little short of—to use the phrase that the noble Baroness, Lady Browning, used—a human rights scandal, and it has to end. I believe that an explicit focus on therapeutic benefit when delivering treatment is one way that the Bill can help to achieve that. We simply must grab hold of this opportunity.

[Lord Kamall (Con)]

My Lords, given that all those who have spoken to this group of amendments have been brief, I shall try to be brief. Once again, I thank the noble Baroness, Lady Murphy, for discussing with me in an exchange of emails over the weekend the intent behind the amendments in her name.

The noble Baroness, Lady Murphy, makes a reasonable point about clauses in the Bill that contain the phrase “likelihood of the harm” or “serious harm may be caused”, because it is assumed that such risks are quantifiable and predictable. I was struck by her observation that psychiatrists, psychiatric nurses and academics have warned about the difficulty of being able to predict episodes of violent behaviour in individuals because the base rate for violence, particularly serious violence, in the population is low. One of the things that we keep saying throughout this debate is that we need to see the evidence and the data, and that that should drive decisions that are being made. Given that, I am grateful to the noble Baroness for sharing the statistics, which I will not repeat but which reinforce the point that she wanted to make.

Considering those statistics, I am sympathetic to two specific points that the noble Baroness made. The first is that making statements about individual risk based on such statistics is complex and possibly unsafe, and, as the noble Baroness said, may be unethical. The second is that it may be helpful to use structured risk-assessment systems in routine clinical practice, if used by appropriately trained staff, to predict possible violence at a group level. However, given that many noble Lords have spoken about patient-centred care and the importance of understanding the individual and their sensory profile, surely we should be looking at patients as individuals, where the clinician better understands the individual patient’s mental state, relevant history and response to treatment given his or her life circumstances.

I will be interested in the Minister’s response to the amendments in the name of the noble Baroness, Lady Murphy, urging the Government to replace wording such as “likelihood of the harm” or “serious harm may be caused”. These terms are inexact and somewhat ambiguous and do not appear to be driven by evidence. Perhaps there are more appropriate terms for more holistic and comprehensive assessments.

Amendment 45, tabled by the noble Baroness, Lady Tyler, proposes that the definition of appropriate medical treatment includes the setting in which treatment takes place. This takes us back to a point made on the first day in Committee by the noble Baroness, Lady Barker, and just now by the noble Baroness, Lady Tyler, that for those with autism and learning disabilities, being held possibly in noisy, bright, busy settings full of people who may be strange to them, and where they may feel powerless and worry about what will happen next, is likely to affect their mental health and well-being. Therefore, surely it is important that we take account of the points made by the noble Baronesses, Lady Barker and Lady Tyler, particularly in Amendment 45.

On Amendment 48, it is really important that care is led by the level of therapeutic benefit. That should be based on evidence to drive those decisions. Given that, I look forward to the Minister’s response.

[Baroness Merron (Lab)]

My Lords, I am most grateful for the contributions that have been made and the amendments that have been tabled.

I turn first to Amendments 37A, 37C, 38A, 38B, 42B, 42D, 42E, 42G and 42H, all tabled by the noble Baroness, Lady Murphy, and spoken to by other noble Lords, including the noble Lord, Lord Kamall, regarding the new criteria. Let me say at the outset that the new criteria explicitly require decision-makers to consider the risk of serious harm and the likelihood of those harms occurring in order to justify detention. Clearly, the reason for this is to ensure that any risks to the public and the patient are consistently considered as part of the assessment process, and to protect patients from lengthy detention when these risks are unlikely to occur. I hope that this will be helpful for some of the debate that we have had.

The amendments tabled by the noble Baroness, Lady Murphy, seek to revise the proposed new risk criteria to remove any mention of risk that “may be caused” or the “likelihood” of the risk transpiring. The purpose appears to be to remove any prospective assessment from the detention decision and instead focus on the risk as it can be established at the time. The noble Baroness, in her introduction, asked about the reasonableness of the words in the provisions, and I understand that this is where the concerns lie. I should also thank the noble Lord, Lord Kamall, for his comments on evidence and data and their importance. In answer to the noble Baroness, I should say that the independent review found that the current criteria for detention are too vague and recommended that the Government should update the detention criteria to be more explicit about how serious the harm has to be and how likely it is to occur to justify detention. The intention of the revised detention criteria in the Bill is not to ask clinicians to make predictions but to clarify that they should consider whether a harm is likely to occur, based on their assessment and knowledge of the person—something that the noble Lord, Lord Kamall, focused on—rather than based on risks which may never occur.

Any consideration of risk arguably preserves the need to look at what might happen rather than what is happening or has happened in more concrete factual terms. We think that it is important that the detention criteria allow clinicians to detain based on the risks that they think are likely to happen, rather than just the risks that have already materialised. This enables them to act early to prevent harm to the patient or others. In line with the intention of the noble Baroness’s amendments, this should be based on personalised individual risk assessments and information about the patient’s history and personal circumstances—again, something that I know noble Lords are exercised by, which is about the individual approach to this.

We did engage again on the changes to the detention criteria last summer, in light of the recommendation on this issue by the pre-legislative scrutiny committee, and to assure ourselves that the detention criteria struck the right balance between allowing clinicians to continue to take early action when they are concerned about a patient’s or others’ safety and the independent review’s concerns that people could be detained on the basis of risks that might never occur.