Mental Health Bill [HL]

Debate between Lord Kamall and Baroness Parminter

Committee stage
Monday 20th January 2025 Lords Chamber

[Baroness Parminter (LD)]

My Lords, I want to say a few things about a couple of the amendments. I thank noble Lords for listening and for recognising the situation. It was powerful to hear that, and I am sure that many in the eating disorder community will be delighted to hear it.

I will not repeat what I said at Second Reading, as there seems no need, but in mentioning that, I want to support the amendment tabled by the noble Baroness, Lady Browning, which picks out the focus on community care and the need for more psychiatrists. I and others have made the case for why CTOs can be valuable for people with eating disorders—and for forensic patients, I understand. The value of the CTO is that the individual is helped to engage in the community with their mental health team. It is a multidisciplinary team, but the anchor is the psychiatrist. The noble Baroness was not sure if this was the right place to put her amendment because it has wider ramifications, but it certainly has value in this debate. CTOs, which I believe should be retained, can work only if there are proper multi-disciplinary teams anchored by a psychiatrist in the community, so that those individuals can be kept out of detained settings and engaged in the community. I thank her for bringing that forward, and I support it.

With regard to Amendment 44, I do not support a maximum duration for a community treatment order, because this is about the individual and what they decide, with their multidisciplinary team. What I like about the amendment tabled by the noble Lord, Lord Scriven, is that it rightly says that we have to review community treatment orders. People’s mental health situations change, and it is important to have step points at which people know they will be reviewed. I do not support a maximum time limit but the break points, which his probing amendment talks about, are worthy of further debate and discussion. I am grateful to him for bringing that forward.

I say with regret that I do not agree so much with the support of the noble Baroness, Lady Bennett, for retaining the automatic referral to a tribunal of any CTO that is lifted. Again, that goes against my sense that CTOs are about what is right for the individual. With eating disorders, there will be cases of CTOs being lifted because the person is no longer able to engage with the community team because the eating order has gone beyond the bounds of the CTO and is compromising their health and putting them, bluntly, at risk of death. I do not see why, in those circumstances, there needs to be an automatic referral to a tribunal. Strengthening people’s rights to go to a tribunal where there is a case for that is right and proper, but, because of my view about personalised care—especially for eating disorders, but this has wider ramifications—I do not support the case for automatic referral.

I know that there are people around the Committee who understand the concerns far better than me, particularly about the high preponderance of people in the black community who are on CTOs. I understand and hear that concern. I tried to get to the bottom of the figures, like the noble Baroness, Lady Bennett, to find out how many forensic patients were on CTOs. Given that you are four times more likely to be in prison if you are a black person than a white person, I tried to work out what the figures were to get the correlation to say whether it is because there are more people in prison that CTOs are preponderantly in the black community. I could not work that out. Equally, I could not work out how many people with eating disorders were on CTOs. I got the Library to try to help me, and it said that the figures are not cut that way and do not work that way. It seems to me that there is an issue about the data that we, and the Minister, are working with to make informed decisions.

I am not sure about the exact terms and conditions of the review that has been proposed by the noble Lord, Lord Kamall, and which in a later group is proposed by the noble Baroness, Lady Tyler, but I think there is an issue about the data out there. It is not helping us, or anyone else, make CTOs work for those where they can work, are working and should work in the future, and is clearly causing a problem. We need to get to the bottom of that.

[Lord Kamall (Con)]

My Lords, I thank all noble Lords who have spoken on this group. I will speak to Amendment 66 in my name and that of my noble friend Lord Howe. One of the motivations when we were considering amendments from our Benches was not only to respond to concerns raised by stakeholders but to probe the Government on why they did not accept some of the recommendations of the pre-legislative Joint Committee. That is the nature of these amendments. To the noble Baroness, Lady Fox, I say that the amendment is meant as a probing amendment to ask the Government why they have not adopted all the recommendations of the Joint Committee.

One of the things that drives many of us—I feel particularly strongly about this, given my background—is why so many people of an Afro-Caribbean background are being detained or are subject to CTOs. The noble Baroness, Lady Parminter, made a valuable point. One of the reasons I have tabled other amendments along those lines, which will be discussed in later groups, is that, after all these years of saying that too many people from the black community are being detained, if we want to do something about it, we need data, and we need to understand why they are being detained. Without the data, it is left to rumour or speculation, or people make up reasons. Everything needs to be driven by the data if we are to address the fact that a disproportionate number of black people are detained.

We tabled Amendment 66 because the pre-legislative committee recommended that community treatment orders be abolished for Part II patients, those not in the criminal justice system, and wanted a statutory process and timeline to be put in place for the review and potential abolition—I say those words from the Joint Committee’s recommendation very carefully—for Part III patients, those involved with the criminal justice system.

Many noble Lords came to the Second Reading debate wanting to see an end to community treatment orders, and many noble Lords have spoken tonight about this. We were all struck by the words of the noble Baroness, Lady Parminter, and of the noble Baroness, Lady Barker, who very honestly said that, having listened to patients and families, she knows that there is a small group of people for whom CTOs work, are the least restrictive option and are beneficial, and we should therefore keep them. I was particularly struck by that. The noble Baroness, Lady Fox, said that people do not change their mind very often, but the views that we brought to the debate in the first place have been challenged.

The noble Baroness, Lady Barker, made the important point that, while she is reluctant to admit it, she believes that there should be a change in the process around CTOs. That is important. This is why this probing amendment is asking for a comprehensive review of CTOs. We have listed a number of criteria that should be in that review, but I know that many noble Lords have concerns over CTOs.

NHS Mental Health Patients in Private Hospitals

Debate between Lord Kamall and Baroness Parminter

Thursday 28th April 2022 Lords Chamber

[Lord Kamall (Con)]

Can I begin by—if my information is correct—wishing the noble Lord a happy birthday? If it is not his birthday, I have made a fool of myself. I am sure all the House joins me.

Wherever there is a tragedy, we have to learn the lessons. We spoke about this during the Bill, for example with HSSIB and making sure we have a safe space to understand what went wrong and ensure it does not happen again. We have to make sure that, as we move towards different models of care for people suffering from mental health conditions, it is appropriate to their condition. Not all mental health conditions are the same. Some will need in-patient provision and others will need care in the community, but we should make sure they are actually supported in the community.

[Baroness Parminter (LD)]

My Lords, I declare an interest in that I have a daughter currently in a private eating disorder facility out-of-area, which the NHS is paying for—for which I am extremely grateful. Given the increasing numbers of people suffering from eating disorders, both children and young people and adults, what hope can the Minister give families like mine that in future their young people and family members will not be sent far away, when we want to see them? They might be in hospital for four, six or nine months at a time. What hope can the Minister give people that—yes, there are brilliant community services for eating disorders and we need more of them—we will open up more beds in local areas to help families and sufferers of these appalling diseases?

[Lord Kamall (Con)]

I thank the noble Baroness for sharing her very personal story. It is important that we understand it is more than stats and figures, which are provided to me by the department. In the community, we understand it is important to make sure that provision is as close to the patient and family as possible. We have to remember that care is not just for the patient; it impacts friends, family and others. We are looking at ways to ensure that care is delivered close to families and those suffering from these conditions.

Eating Disorders

Debate between Lord Kamall and Baroness Parminter

Tuesday 1st March 2022 Lords Chamber

[Baroness Parminter]

To ask Her Majesty’s Government, further to the report of the Parliamentary and Health Service Ombudsman Ignoring the alarms: How NHS eating disorder services are failing patients, published on 6 December 2017, what steps they are taking to ensure that eating disorders are taught appropriately in medical schools.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

My Lords, following the Parliamentary and Health Service Ombudsman’s report regarding the tragic death of Averil Hart, the Department of Health and Social Care has been engaging with partners through a delivery group led by NHS England and NHS Improvement to continue to address the recommendations. This includes work with Health Education England to improve training for GPs and with the General Medical Council to ensure that eating disorders are included among outcome measures for newly qualified clinicians.

[Baroness Parminter (LD)]

I thank the Minister for his reply. GPs receive on average less than two hours’ training for eating disorders. Inadequate training was identified by the PHSO report in 2017, as he says, and by numerous coroners’ reports since then, including the latest Prevention of Future Deaths report in Manchester in December following the tragic death of Nichola Lomax. What specifically is the Minister doing to hold the GMC, the Academy of Medical Royal Colleges, Health Education England, NHS England and NHS Improvement to account for their responsibility to ensure that trainee doctors graduate with the skills and the knowledge to be able to identify, safely manage and refer patients with eating disorders?

[Lord Kamall (Con)]

The noble Baroness raises a very important point about how we identify the issues and tackle them. It is two-pronged: one way is about the amount of investment into mental health services, including tackling disorders, and the other is training. NHS England and NHS Improvement have been working with Health Education England and other partners to look at training courses that will increase the capacity of the existing workforce to provide evidence-based treatment to more people. We are also working with the GMC and the Academy of Medical Royal Colleges as well as Beat representatives. In addition, Health Education England is looking to increase the exposure of doctors to eating disorders. The GMC’s Outcomes for Graduates states that

“Newly qualified doctors must explain and illustrate”


their understanding of

“the principles for the identification, safe management and referral of patients with mental health conditions”,

including eating disorders.

Eating Disorders

Debate between Lord Kamall and Baroness Parminter

Monday 17th January 2022 Lords Chamber

[Lord Kamall (Con)]

First, I pay tribute to the noble Baroness for all the work she has done in this area, making sure that we are all aware of this issue and keeping it on the agenda. In answer to her specific question, the department has invested nearly £110 million in mental health research, including research on eating disorders through the NIHR, as she mentioned. This includes the Eating Disorders Genetics Initiative and a systemic review led by the Evidence for Policy and Practice Information and Co-ordinating Centre. UKRI has announced funding for a £3.8 million study on eating disorders to inform prevention and early prevention in young people. This research is being led by King’s College London and the University of Edinburgh.

[Baroness Parminter (LD)]

My Lords, the latest NHS data shows a continuing increase in the number of people being hospitalised for eating disorders, mainly in the 18 to 39 age group, yet there is still no adult waiting time standard for people with eating disorders. This is despite knowing that access to quality community care can reduce the number of hospitalisations and unnecessary deaths. When are this Government going to introduce an adult waiting time standard for people accessing treatment for serious eating disorders?

[Lord Kamall (Con)]

As noble Lords can imagine, because of the pandemic, sadly, waiting times have gone up, but we are making sure that we are doing as much as we can to address that. Longer term, we are focusing on prevention, not only cure. We are also making sure that we are able to understand the various forms of eating disorder better. It is very simple to lump them all together, but there are different elements and you can distinguish between them. Then we will, I hope, be able to tackle that as much as possible.