Mental Health Bill [HL]

Debate between Lord Kamall and Lord Bradley

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.

Health and Care Bill

Debate between Lord Kamall and Lord Bradley

Lords Hansard - Part 1 & Report stage
Tuesday 1st March 2022 Lords Chamber

[Lord Kamall (Con)]

My Lords, with the leave of the House, I hope that noble Lords will find it helpful for me to speak early in this debate, since we believe that government Amendment 31 addresses some of the concerns raised by noble Lords. I shall, of course, listen carefully to the rest of the debate and respond in full at the end.

In speaking to Amendment 31, I thank noble Lords from across the House for the wide-ranging discussions in the Chamber on membership of ICBs. We are grateful for the discussions. Many noble Lords have offered their gratitude to the noble Baroness, Lady Walmsley, for the suggestion on the skills mix. We accept the spirit of these amendments and agree that it is important that ICBs are populated by members with the appropriate range of skills and expertise. I know that noble Lords have heard this many times, but it is also important that we do not over-prescribe, as ICBs should have the flexibility to design their boards to meet their needs, while also ensuring they have the skills and experience necessary to properly discharge their functions.

We have listened, and I hope that the amendments we have brought forward, which require ICBs to consider these skills, knowledge and experience, address those concerns while also ensuring balanced, workable boards. When the amendments refer to the necessary skills, knowledge and experience, that is in relation to the discharge of all the ICBs’ functions, including those related to mental health, children’s health, public health, public and patient involvement, engagement with the voluntary, charity and social enterprise sector, and digital innovation and integration. Therefore, these amendments would help to ensure confidence that ICBs have the necessary skills and expertise to discharge these functions, while allowing them to retain discretion in how they deliver this. This approach has been welcomed by stakeholders, including the Allied Health Professionals Federation, which represents 12 professional bodies representing allied health professionals.

The second, connected amendment would ensure that an ICB reports on how it has discharged this new duty in its publicly available annual report. This will allow public scrutiny of ICBs and create confidence that they are drawing on an appropriate range of skills, expertise and knowledge. This is in addition to governance of ICBs being clearly set out in their constitutions, which will also be published and signed off by NHS England. As I have said, I shall listen carefully to the rest of the debate, but at this stage, for these reasons, I commend these amendments to the House.

[Lord Bradley (Lab)]

My Lords, I rise to speak to this group of amendments, but particularly to move at the appropriate time my Amendment 12. Again, I declare my health interests in the register, especially as a trustee of the Centre for Mental Health and an honorary fellow of the Royal College of Speech and Language Therapists.

As we have heard, we had considerable discussion about membership of ICBs in Committee. I argued in an amendment that membership of ICBs should include a representative of a mental health trust. I also supported amendments stating that allied health professionals—who make up about a third of the health and social care workforce, within which speech and language therapists are a crucial service—should also have membership on the board. However, as we heard, the Government rejected the arguments, principally on the grounds that they made membership too prescriptive and inflexible.