Mental Health Bill [HL]

Lord Patel Excerpts

Committee stage
Monday 20th January 2025 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I want briefly to make a couple of comments on this important group. As everyone has acknowledged, an absolutely vital change to the Bill is that, in the future, people with learning disabilities and autism will not be detained by the Bill and their needs are to be met in the community. I am sure we can all agree on and gather around that.

The noble Lord, Lord Beamish, made the point that, far too often in the past, people with learning disabilities and autism have been overlooked. I see the Bill as a real opportunity to do something substantive about that. That is why I note some of the amendments we have heard about in this group—certainly those in the names of my noble friends Lord Scriven and Lady Barker, and others—about the importance of having properly trained staff with up-to-date knowledge and expertise, as the noble Baroness, Lady Bennett, has just mentioned.

For any of this to happen, it is important that there is a proper plan, that is costed; the resources need to be available, and properly trained staff with up-to-date expertise need to be available in the community. To ensure that there is some sort of accountability around all this, I reiterate the question that my noble friend Lord Scriven asked the Minister: when will we see new targets—we have not got any at the moment—to reduce the number of detentions of people with learning disabilities and autism? It would be helpful to know that those targets will be put in place and that there is some way of monitoring the progress on all the important things we have been talking about in this group.

[Lord Patel (CB)]

I agree with what has been said: we need a definitive plan for how things will work out. We cannot rely on it being in five or 10 years because, as the noble Baroness, Lady Murphy, said, it then just becomes an ambition rather than a target to achieve.

I support the amendment of the noble Baroness, Lady Browning, which strongly asks that the people who look after children with autism and learning disabilities are properly assessed by properly trained and accredited people. We know that, currently, children are ending up in detention inappropriately because they are assessed to have a psychiatric condition such as schizophrenia—as the noble Baroness, Lady Browning, said—when, although they might have some psychiatric sub-condition, they fundamentally have autism or learning disability problems.

I am sorry that the noble Lord, Lord Adebowale, is not here to speak to his Amendment 150, which asks quite powerfully for a clear plan to be laid out, with resources tied to it, to achieve the ambitions there are in the Bill. I would have supported his amendment probing the Minister as to how resources will be allocated to achieve the ambitions for those targets to be met.

[Lord Kakkar (CB)]

My Lords, I support Amendment 42A in the name of the noble Baroness, Lady Browning, and I ask the Minister what justification there could be for refuting the amendment. It seems entirely appropriate, and indeed essential, that in taking such an important, far-reaching decision, one of the two registered medical practitioners who is responsible for that decision, taken at one point in the management of the natural history of disease in that individual, has the specialist skills and training to be able to make an appropriate assessment, one that will affect interventions on all future occasions for that individual.

I hope that, in addition to accepting this important principle, the noble Baroness might outline how His Majesty’s Government will go about ensuring that the development of such medical practitioners and their training is adequately resourced to ensure that, in future, as a result of the Bill being enacted, what we have seen in the past, regrettably on repeated occasions, does not remain the norm for managing patients with autism and learning disabilities.

First-cousin Marriage

Lord Patel Excerpts

Monday 20th January 2025 Lords Chamber

[Baroness Merron (Lab)]

I thank the noble Lord for his support in this area, which is indeed sensitive. The statistics he quotes are quite right. It is of course an interesting reflection that the risk of genetic abnormalities does not just double from 3% to 6% in those infants whose parents are first cousins, but also doubles in older white British mothers—I am a bit worried about saying “older” because it is actually over 34. However, the point is well made that it is not just this group. NHS England has recently published guidance to improve the recording of national data on closely related couples, so I hope that noble Lords will find this of interest as we go along. But of course, there has also been much investment in research as well as data development, and I absolutely agree that data is what has to drive us.

[Lord Patel (CB)]

My Lords, we know that there are over 6,000 genetically related rare diseases and that, apart from first-cousin marriages, there are other high-risk areas. One, which the Minister just mentioned, is the age of the mother, but this also applies to the age of the father, to people who undergo certain medical technology treatments for fertility reasons, and to mothers who smoke at a higher rate. So, there are lots of other influences that may give rise to genetic-related issues at birth. But the important question is: are there any areas where we can definitively say, “If you do X, Y and Z, or if you do not do X, Y and Z, the incidence of genetic diseases will be reduced”?

[Baroness Merron (Lab)]

The noble Lord is absolutely right that there is a whole range of factors in this area, and I am grateful to him for bringing that before your Lordships’ House. He will of course be aware of the main pillars in the 10-year plan: for example, moving from sickness to prevention, which is key. The noble Lord also mentioned tackling smoking, which we will continue to drive forward. But I wanted to use the Question to highlight that the NIHR is undertaking research projects into improving early recognition, diagnosis and treatment of specific genetic and congenital diseases, particularly in communities with high rates of marriage between close relations. So, to the specific point, I again hope that that will be helpful.

Mental Health Bill [HL]

Lord Patel Excerpts

Tuesday 14th January 2025 Lords Chamber

[Lord Patel (CB)]

My Lords, I will speak briefly in support of all these amendments, including Amendment 114 in the name of the noble Baroness, Lady Whitaker. I apologise for having to scratch my name from the speakers’ list at Second Reading, as I had been struck down by the dreaded virus.

In all areas of healthcare, communication between patient and healthcare professionals is extremely important for diagnosis and treatment, and to achieve the necessary outcomes. This is drummed into medical students and other health professionals daily.

I declare an interest: I am an honorary fellow of the Royal College of Psychiatrists—an honour awarded to me by the noble Baroness, Lady Hollins, who is not in her place, when she was its president. The citation of unknown accomplishments in mental health on my part was read out by the noble Lord, Lord Alderdice, who is also not in his place.

I remember, however, that although my professor at the time, Sir Ivor Batchelor—a well-known psychiatrist—was a quiet man, during our psychiatry clinical attachments he used to drum into us that not all mental health patients can communicate well. We had to be patient to learn and understand their ways of communicating to help them communicate their problem. I had forgotten that I was taught that; at the time, I think he hoped that he would make us all psychiatrists, but that did not happen.

The noble Baroness, Lady Whitaker, has highlighted the extent to which patients with mental health problems have communication disability, difficulty or difference. NHS Digital research has shown that children and young adults with mental health problems are five times more likely to have communication problems, and that in 81% of children with social and emotional needs their needs remain unidentified. Even without communication disability, difficulty or difference, people with chronic acute mental health problems also show communication problems.

As the number of people with complex mental health needs increases, so does the need for more speech and language therapists. Very few multidisciplinary teams include such professionals and, where they do, most of the professionals work in in-patient settings. NHS Digital research suggests that there are about 256 such professionals, mostly working in in-patient secure settings. The provision of such services in community settings is patchy or non-existent, leading to long waits.

--- Later in debate ---

[Baroness Murphy (CB)]

My Lords, I shall speak to Amendment 49 on this issue. I do not disagree with anything that has been said about the vital need for communication and to ensure that the patient understands what is happening and has access to specialist help. But I particularly want to comment on the proposal that speech and language therapists should become responsible clinicians.

The role of responsible clinician under the Mental Health Act is really quite onerous. Of the 50,000 or so clinicians who take on the role and are appointed the responsible clinician when somebody is detained, the vast majority are consultant doctors. Fewer than 100—0.002%—have been psychologists or nurses. The appetite for taking on this role is low and, of all the members of the team who could take it on, it would be appropriate only in a very small minority of cases for it to be speech and language therapists. I do not want to rule them out because I know how valuable these people are, but we must see that, in practice, this will probably not fly very far. It is important that we concentrate on how we get proper communications, but this particular amendment would probably not find favour. I do not think that profession is yet trained to the full extent of what would be required for that role. Although I hope that it will be one day, this Bill is maybe too early for it.

[Lord Patel (CB)]

My Lords, with the greatest respect to the noble Baroness, I did not suggest—and I did not hear any other noble Lord suggest—for a minute that language and speech therapists would become clinicians in their own respect. I said that they would be part of a team that would help to establish appropriate communication. As doctors, we are not the best people for that—so I do not see how the amendment cannot fly, when there is a need for such people.

[Baroness Murphy (CB)]

I entirely agree with the noble Lord. However, the reality is that the responsible clinician, as mentioned in Amendment 49 to Clause 10, has a wide range of roles. It is very onerous and specific, so this is not likely to be a good idea for a speech and language therapist. I agree with the rest of what everybody has said.

Health and Adult Social Care Reform

Lord Patel Excerpts

Tuesday 7th January 2025 Lords Chamber

[Baroness Merron (Lab)]

The independent review by the noble Baroness, Lady Casey—in addition, as I mentioned, to producing recommendations that can be implemented straight away next year—is focusing on completing its final report later in this Parliament, so we are looking at the longer term. I cannot give an exact timetable, although I am hopeful that we will be able to update your Lordships’ House with further information, as the noble Baroness quite rightly asked. The matter of discharge requires there being suitable facilities in the community, but we are not in that place, so this will take some time. But I am very hopeful that all of the measures here, and the measures we have taken already, take us further to that point. We will continue to strive on the matter of discharge, because it is a problem not only for the NHS but for patients and their carers and for social care. We are carrying, as we know, a lot of vacancies and a social care system that is creaking at the seams: we must be honest about that.

[Lord Patel (CB)]

My Lords, I welcome the Statement and many of the proposals in it. We have learned from past experience that all reforms to, and any proposal to change things in, the NHS—and, for that matter, social care, but more so with the NHS—lead to increased bureaucracy but not the benefits that we thought they might deliver. One of the waiting list initiatives is that GPs will have a consultation with hospital staff to try to reduce waiting times and avoid unnecessary duplication. There is some financial incentive attached to that, but it certainly will increase bureaucracy. What modelling has been done to find out whether it will work, whether it will increase bureaucracy and by how much it will increase costs?

[Baroness Merron (Lab)]

I am grateful to the noble Lord for welcoming many of the measures in this announcement. He referred to the £20 fee that will be paid to GPs to call the consultant where necessary. I understand the concern about increasing bureaucracy, but all these reforms are intended to work the other way. We will very closely monitor them and have very carefully considered them with all those who will be dealing with them. I am actually more than hopeful, because the intention is that allowing the GP, for example, to get further advice, and making sure that people are being seen in the right place, will save money. It will mean that people are not taking up a referral place and that they will be referred for the necessary tests, scans, et cetera without the middle bit, which is a very backward-facing way of dealing with things. We will continue to monitor that to ensure that we are reducing what is currently wasted clinical time, while also preventing unnecessary out-patient appointments. The monitoring should show all of that and I will be very happy to update the House on that. The fee is to ensure that it can happen and is an incentive to do so. Of course, the greatest prize is an increased and speedier service for patients.

Health: Obesity

Lord Patel Excerpts

Tuesday 7th January 2025 Lords Chamber

[Baroness Merron (Lab)]

I certainly agree with the noble Lord about the need for favourable alternatives, and to educate people, particularly at a young age, about what healthy eating can look like, but it is also important to create the right environment and circumstances, and not everybody has that to hand. The provision of free school meals in the way the noble Lord referred to is of course a matter for local government to decide. I can say that the Scientific Advisory Committee on Nutrition has reviewed the evidence about ultra-processed foods and believes that further research is needed, which we have commissioned. Importantly, the committee has added UPFs to its watching brief and many are covered by existing legislation, because there are regulations on foods high in fat, salt and sugar which are applicable to ultra-processed foods.

[Lord Patel (CB)]

My Lords, I am delighted to hear the Minister say that the department has commissioned some more research. The small amount of research that is available suggests that processed, and particularly ultra-processed, food causes addiction, stimulating some dopamine centres, and that people who consume ultra-processed food want more food. In a small study of two groups of people, one consuming ultra-processed food and the other not, it was found that far more calories were consumed by those eating ultra-processed food. I would be glad to hear what research the department has commissioned to address this issue.

[Baroness Merron (Lab)]

The noble Lord raises a very interesting point. It is certainly the case that those who consume ultra-processed food have around 50% of their calorific intake through that matter. Where there is not clarity is on whether the foods are unhealthy due to processing or to their nutritional content. On that, the jury is out. We need to establish that. That is the why the Government’s Scientific Advisory Committee on Nutrition has concluded that the association between UPFs and health is concerning. We need to get to the bottom of why that is.

Bread and Flour Regulations 1998

Lord Patel Excerpts

Wednesday 11th December 2024 Lords Chamber

[Baroness Merron (Lab)]

Please do not apologise. We are seeing through all the measures that are possible to reduce dental decay as part of our prevention policies, and that includes introducing supervised toothbrushing for young children. I know that a number of noble Lords are interested in the matter of fluoridation—they have raised it with me in discussions about dentistry—and I will be pleased to write to my noble friend.

[Lord Patel (CB)]

My Lords, the noble Lord, Lord Rooker, is right to mention Nick Wald; he pioneered the study that I was part of when I was on the steering committee of the MRC. The important point I want to make is that it is before pregnancy starts and in its early phases that folic acid is most important; it is not about prescribing it once the pregnancy is established. I speak as someone who had to look after many mothers who had neural tube defects, such as anencephaly.

[Baroness Merron (Lab)]

The noble Lord’s observation is, obviously, right. Folic acid contributes, for example, to tissue growth during pregnancy, as well as to the normal function of the immune system and to reducing tiredness and fatigue. As for the point I made earlier, one of the strong reasons for this policy is that 50% of pregnancies are not planned. Therefore, it is about ensuring that folic acid is available in a diet before pregnancy, whether or not that pregnancy is planned. That is vital.

Anti-depressants: Cost, Risks and Ramifications

Lord Patel Excerpts

Wednesday 11th December 2024 Lords Chamber

[Baroness Merron (Lab)]

I extend my deepest sympathies to the family of Thomas Kingston after his very tragic death earlier this year. We await the findings of the inquest and will act on any recommendations by the coroner as appropriate. While there has been an increase in prescribing, as the noble Lord observes, anti-depressants, for example, are often prescribed for a wide range of reasons—not just for the treatment of depression but for migraine, chronic pain, and ME, among other conditions. The other possible reason for the increase is because of the stigma associated with seeking mental health treatment, but prescribing anti-depressants is never the first port of call—it is just one of the tools in the box to assist people. There are no current plans to conduct a review.

[Lord Patel (CB)]

My Lords, the noble Lord, Lord Alton, did not mention whether we were discussing specific anti-depressants, but the case he mentioned does refer to a group of anti-depressants called selective serotonin reuptake inhibitors. They treat the patient by increasing serotonin levels, but they run the risk of patients having suicidal ideation—the feeling of wanting to commit suicide. In a meta-analysis carried out using 29 research reports, it was found that they are beneficial in the early phase of the treatment of depression, but in later phases the data is less reliable. Are the MHRA and the NIHR working together to look at the evidence available and to produce the appropriate guidance? To avoid a high risk of suicide in people using this group of drugs, it is important to have proper monitoring, which means controlled visits to appropriate health specialists.

[Baroness Merron (Lab)]

I assure the noble Lord that NICE keeps all its clinical guidance under active surveillance to ensure that it can respond to any new evidence that is relevant, including relevant clinically related literature, that could possibly impact on its recommendations. More broadly, guidance recommends that suicidal ideation should be monitored in people with depression who are receiving treatment, particularly in the early weeks of treatment. That includes specific recommendations on medication for people at risk of suicide.

Health: Quad-demic

Lord Patel Excerpts

Tuesday 10th December 2024 Lords Chamber

[Baroness Merron (Lab)]

We are absolutely committed to learning the lessons from Covid in order to build resilience. The recommendations of the independent review of procurement by Nigel Boardman have already been implemented and a Covid Counter-Fraud Commissioner has already been appointed to scrutinise contracts to learn the lessons and recover money for taxpayers. Professor Sir Stephen Powis, who I have spoken to about this, was not suggesting that there is a pandemic but more that four infectious diseases are coalescing to create a situation and that vaccination is crucial. His comments were a call to the public to get vaccinated, which I also endorse.

[Lord Patel (CB)]

My Lords, currently the RSV vaccination is available to the older age group of 75 to 79 year-olds—of course, it is available to a younger age group for vulnerable people—unlike in the CDC advice, which is that over-75s should get the immunisation. Older people are more susceptible to RSV and end up with more severe disease and hospitalisation, so why is the advice in the United Kingdom that the over-80s should not get immunisation? It has been suggested that the trials had insufficient evidence. The two trials for Moderna and Pfizer showed that efficacy was maintained in the older age group and therefore the JCVI’s interpretation is rather narrow in scientific terms —or is it to save money?

[Baroness Merron (Lab)]

I listened carefully to the noble Lord. The JCVI considered that there was less certainty about how well the RSV vaccine works in people aged 80 and over when the programme was introduced in 2023, and that is because, as the noble Lord said, there were insufficient people aged 80 and older in the clinical trials. The JCVI continues to keep this under review, including looking at data from clinical trials and evidence in other countries, and there will shortly be an update to your Lordships’ House in respect of research and clinical trials.

Cancer: Older People

Lord Patel Excerpts

Tuesday 19th November 2024 Lords Chamber

[Baroness Merron (Lab)]

My noble friend is quite right that the incidence of cancer is expected to rise across the UK, especially in older people. I agree that older people can face specific barriers when accessing care. Following on from the independent review by the noble Lord, Lord Darzi, I assure my noble friend that the 10-year health plan and the subsequent cancer strategy for England, both to be published next year, will help us do more to prevent cancer, identify it early and treat people quickly. They will have regard to older people.

[Lord Patel (CB)]

My Lords, I am delighted to hear that we will have a new cancer strategy. I have tried to get a debate in this House on that for two or three years now. Maybe the Minister will use her influence with the powers that be so that we can have a government-led debate on the cancer strategy. However, one of the reasons why our outcomes are poor is late diagnosis of cancer. Only 54% of cancers are diagnosed at stages 1 and 2. What plans do the Government have to improve early diagnosis of cancer?

[Baroness Merron (Lab)]

I am sure the powers that be heard what the noble Lord said about a debate. On the point he raised, I absolutely agree that diagnosing cancer earlier, at stages 1 or 2, improves outcomes and survival. I refer again to the report by the noble Lord, Lord Darzi: we need to do more to diagnose people at an early stage. Work is already being undertaken to improve cancer screening uptake. We will continue to roll out targeted interventions such as the lung cancer screening programme, which has a particular effect and impact on the most disadvantaged areas. Members of your Lordships’ House will know that the Budget also committed to £1.5 billion of capital funding for new surgical hubs and diagnostic scanners, which will increase capacity.

Type 2 Diabetes: Continuous Glucose Monitors

Lord Patel Excerpts

Tuesday 19th November 2024 Lords Chamber

[Baroness Merron (Lab)]

The noble Lord makes a very fair observation. Work is going on in a wider equality monitoring programme exploring how to keep an eye on equality repercussions, including ethnicity, by reference to protected characteristics in the Equality Act 2010. Importantly to the point he raised, the review includes consideration of how NHS ethnic group categories can be updated. The outcome of the review—this is the point I really want to emphasise—will ultimately guide a process of reducing inequalities, but I accept his challenge and his point.

[Lord Patel (CB)]

My Lords, there is a strong link between body mass index, BMI, and type 2 diabetes. People with a body mass index of 25 to 30 have an 8% chance of developing type 2 diabetes; those with 30 to 40 have a 20% chance; and those with a body mass index of 40 or over have a 40% chance. One way of monitoring long-term glycaemic glucose levels is to measure haemoglobin A1C. It might therefore be an idea to use haemoglobin A1C levels to diagnose early type 2 diabetes, initially in people with a BMI of 40 or over, as a screening tool. It might be an idea to ask NICE or the screening committee to evaluate that likelihood.

[Baroness Merron (Lab)]

The noble Lord makes a helpful point. I can tell your Lordships’ House that diabetes testing is included as part of the NHS health check. If a person is identified as being at high risk of type 2 diabetes, they should be offered a blood sugar glucose test or a fasting glucose test. NICE produces guidelines on preventing type 2 diabetes in people at high risk, and that includes recommendations on risk assessments, including blood testing, which can include people with a high BMI. His point is extremely valid, some of that is in place and we will ensure that it continues.