Learning Disabilities Nursing

Lord Scriven Excerpts

Tuesday 17th June 2025 Lords Chamber

[Baroness Merron (Lab)]

The noble Baroness is quite right. One of the difficulties is that sometimes there is misdiagnosis, where it is incorrectly assumed, for the very reasons that the noble Baroness gives, that the presenting condition is the learning disability when actually it is a different condition. I agree about the need that the noble Baroness outlines. In reports such as the LeDeR review and Transforming Care, there is a national focus on reducing health inequalities and increasing awareness of this very point about diagnostic overshadowing. I will ensure that that is key to what we are doing.

[Lord Scriven (LD)]

My Lords, the Minister just referred to the LeDeR report, which points out the persistent avoidable deaths of people with learning disabilities. Yet we now have a seven-month delay for the latest annual report, which shows a lack of urgency. Does the Minister agree that this leads to a genuine perception that the sector’s critical concerns are not being prioritised, and that this in itself hinders promotion of learning disabilities nursing?

[Baroness Merron (Lab)]

It is probably helpful to say to your Lordships’ House that there have been significant changes to how we respond to care for individuals with learning disabilities within the UK. Like in other specialist areas, there is a move towards multidisciplinary teams, which I certainly welcome. I also emphasise the role of learning disability nurses, who are absolutely key, as is the training of all staff. That is why we are so committed to rolling out the Oliver McGowan training, which I know is highly regarded by all staff.

Creon

Lord Scriven Excerpts

Thursday 5th June 2025 Lords Chamber

[Baroness Merron (Lab)]

The supply situation has improved since last year and there is now sufficient stock of lower-strength Creon to meet normal demand. There are still some supply constraints, as I have said, with the higher-strength product stock, but stock is regularly being delivered to pharmacies. As we have discussed, alternative products and unlicensed imports are also available. I totally accept that patients may have concerns, and that is why we have worked closely to keep in communication with patients to assure them that they will not be going without the medication they need. For example, it may be that lower strength in multiple provision can be made, or there are the alternatives that I have described. If any noble Lords are aware of real-life examples of shortages, I would be grateful to hear about them, because we believe that we have made the arrangements, and I can reassure noble Lords that these very important medicines are being provided to those who need them.

[Lord Scriven (LD)]

My Lords, I suggest that the Minister ask her officials immediately to speak to the National Pharmacy Association, which published a survey at the end of last month that said that 96% of community pharmacies were finding problems with getting stocks of Creon and 89% of community pharmacies were having problems with alternatives. In light of that and the bigger picture, what actions are the Government taking to establish new suppliers and manufacturers of enzyme replacement therapy to reduce reliance on a limited number of manufacturers?

Primary and Community Care

Lord Scriven Excerpts

Thursday 5th June 2025 Lords Chamber

[Baroness Merron (Lab)]

I am very glad that the noble Lord asked for permission. I take his point. I know that he understands the value of in vitro point-of-care testing, but he makes the good point that what matters is what is clinically appropriate in the circumstance. We would all expect that to happen for the benefit of the patient.

[Lord Scriven (LD)]

My Lords, I will follow on from the Minister’s Answer. While being supportive of the general trend, what metrics and measures have the Government put in place to ensure that those tests indeed create positive patient outcomes and healthcare efficiency to help future induction of the tests in the NHS?

[Baroness Merron (Lab)]

We will ensure, through our 10-year health plan, that the additional tests, including in vitro point-of-care diagnostics, are taking place in the community. I look forward to being able to provide more information to the noble Lord.

Young Children: Convenience Foods

Lord Scriven Excerpts

Wednesday 4th June 2025 Lords Chamber

[Baroness Merron (Lab)]

On the three ways forward that the noble Lord identified, the approach often has to be a mix of all three. It is the balance that is the point under debate, and it has to be informed by evidence. I certainly share the noble Lord’s view about the importance of civil society and working with community groups. Indeed, my department, but also the Department for Education and other departments, have worked closely with community groups in order to advance the policies and practices we need to improve the health of the youngest in our communities.

[Lord Scriven (LD)]

My Lords, the Scientific Advisory Committee on Nutrition recommends that free sugars are limited for babies and toddlers, yet it reported that our children have excess sugars and 20% comes from snacks aimed at young children. How do the Government plan to ensure that manufacturers are taking actions that do not directly contribute to childhood obesity?

[Baroness Merron (Lab)]

Further to my answer to the last question, we are taking a multifaceted approach. The advice that we give to parents and carers is important, because the noble Lord raises a very important point about not overusing snacks. Although the regulations are roughly the same across the UK and the EU, in the UK we recommend that six months is the point of weaning, whereas across the EU it is four months. So there is some lack of clarity, although we are very clear about where snacks are not needed, which is up to the point of 12 months. We work to ensure not only that people have regulations for protection but that parents and carers are aware of what they should do in terms of providing a healthy and balanced diet for their children.

Doncaster Royal Infirmary

Lord Scriven Excerpts

Monday 12th May 2025 Lords Chamber

[Baroness Merron (Lab)]

I am very aware of the unacceptable situation that the right reverend Prelate describes. I can confirm that, in terms of capital commitments, in 2025-26 the Government are backing NHS systems with over £4 billion in operational capital, £750 million of targeted estate-safety funding, which will be crucial to DRI, as well as £440 million to tackle crumbling RAAC. Why is this all so important? It is all about keeping staff, patients and their families safe, and it is also about providing the best possible care. I should say that the Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, which DRI comes under, is discussing—indeed, it absolutely should be discussing—options with the ICB to steer the programme allocations towards DRI.

[Lord Scriven (LD)]

My Lords, system allocation guidelines of January this year state that systems will receive at least 80% of their 2025-26 core operational capital in each year of this Parliament, relative to their 2024-25 allocation. With many hospital buildings in serious financial capital backlog, why have the Government put in a system that could see some areas’ day-to-day capital allocation cut by 20%?

[Baroness Merron (Lab)]

I can tell your Lordships’ House that we have inherited an undercapitalisation over the past few years, and it is essential—including to cut waiting lists and provide proper care—that we provide resources. However, the noble Lord is very aware of the extent of the backlog; it stands, according to the latest NHSE figures for 2022-23, at £13.8 billion. Even more worryingly, the critical infrastructure risk within that, which the highest-tier hospitals are wrestling with, is £7.6 billion. We have had to find the best route forward to be fair and efficient. Is it a major mountain to climb? Yes, it is. Are there various options for doing it? Yes, there are, but we believe that we have been as transparent and fair as we can be.

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[Baroness Merron (Lab)]

On that point, I feel that the Government taking the backlog very seriously, against the background of what we have inherited, will make conditions far better for staff, which will make it a far more attractive place to work. That will be reflected when we report on the workforce plan. To the point about maternity, we are recruiting extra midwives and we are looking extremely closely at how we can better support best practice—as I saw just last week—how we can extend that and how we can bring better patient safety measures into the system. I am afraid that it is another area that we inherited in a difficult position, but noble Lords can be assured that we are working on it. I look forward to updating your Lordships’ House.

[Lord Scriven (LD)]

My Lords, I am going to come back at the Minister. I accept that the backlog is there. My question was: why have the Government put in a system that will reduce day-to-day capital expenditure, potentially by up to 20%, for some areas? That is this Government’s new plan. The Minister said at the Dispatch Box that the ICB in South Yorkshire has been allocated £150 million this year. It was allocated £161 million last year. How does this help Doncaster, Sheffield, Rotherham and Barnsley with their capital backlog?

[Baroness Merron (Lab)]

I understand that the noble Lord is, as I am, very keen to resolve this situation, but the fact is that DRI is in an extremely difficult place, which was the reason for the right reverend Prelate’s Question. To pursue the particular point he made, I will be very pleased to come back to him. However, I emphasise that the Autumn Budget made exceptional support for capitalisation, which is not just for the physical estate but also the digital estate. DRI has, for example, been updating patient records on paper. That is not the way forward and they will now be digitally brought up to date. On his particular point, I will be very pleased to look into it further and come back to him.

Dementia and Alzheimer’s Treatments

Lord Scriven Excerpts

Thursday 1st May 2025 Lords Chamber

[Baroness Merron (Lab)]

That is a very helpful offer which I will be pleased to accept. I compliment York on its initiatives, which set a very high standard. I will also discuss the points that the noble Baroness has raised with Minister Kinnock, who is the responsible Minister in this area.

[Lord Scriven (LD)]

The previous question shows how the rollout and co-ordination of good practice are really important. Therefore, in light of the 50% staffing cuts to NHS England, can the Minister clarify the plan for the national dementia team which sits within NHS England? Will its core funding and capacity be protected or cut?

[Baroness Merron (Lab)]

We are abolishing NHSE. It is the biggest quango, and we are finding immense duplication. At this stage, I cannot comment on the exact matter to do with the team, but I can say that dementia work continues to be a very high priority, as I hope the noble Lord heard from my commitment to the noble Lord, Lord Evans. Indeed, we are keen to support not just those at risk of dementia but those who care for them. This is an expanding area of work. We have much good practice to draw on and we are extremely active, as the noble Lord has heard, in developing research to move further forwards more quickly.

Tobacco and Vapes Bill

Lord Scriven Excerpts

2nd reading
Wednesday 23rd April 2025 Lords Chamber

[Lord Scriven (LD)]

My Lords, it is a pleasure to follow the noble Lord, Lord Naseby. He talked about his long history in the industry since 1963; I was born three years after he started. For nine months in my mother’s womb I was a passive smoker, because she was a smoker.

The Bill is driven by noble intentions. Quite rightly, it seeks to protect future generations from the serious harms of smoking and the trend of vaping in young people. These are very good public health objectives and ones that I support, as I saw both of my parents’ lives cut short due to smoking-related diseases. I support many provisions within the Bill, but I have serious reservations about the centrepiece: the so-called smoke-free generation. This mechanism raises profound practical, legal and philosophical problems.

I start with the principle which underpins my objections: individual liberty, which I, as a Liberal, consider to be the foundation of a free society. In the United Kingdom, the legal age of adulthood is 18 and, at 18, citizens can make many bad choices that carry risks with them. These include drinking alcohol, gambling and, currently, purchasing tobacco. The Bill proposes to strip away one of these rights from some adults because of the year in which they were born. Personal liberty and individual choice play no part for those adults.

Consider, if you will, two young adults, perhaps twins, born a minute apart, one just before midnight on 31 December 2008 and the other just after, on 1 January 2009. Under the Bill, when they become 18, one would be able to legally buy tobacco for the rest of their lives and the other may never do so. The Bill creates, for the first time, two classes of adult citizens with different legal rights based not on action or consent but on something entirely out of their control: their date of birth. The Government have an interest in protecting public health, but that interest must always be balanced against personal liberty and equity before the law. The Bill does not do that. It creates an unjustifiable inequity in the law.

Even if one were to set aside these philosophical concerns, there is a more immediate issue that we must grapple with: enforcement. Laws that cannot be enforced are worse than being ineffective; they breed contempt for the very institutions that create them. I fear this Bill falls squarely into that category. Not only will retailers be expected to verify that a consumer is over 18 but that will continue for years to come. Imagine the confusion at the tills and the inevitable mistakes, disputes and frustrations. In time, a 35 year-old will be legally permitted to buy tobacco while a 34 year-old will not be. Who will be checking their ID, and how will they make sure that that distinction is absolutely clear?

Also, let us not forget the social dynamics: siblings, friends and parents still legally allowed to purchase tobacco will inevitably be asked to buy—and even pressured into buying—tobacco for adults who cannot. Can you imagine a smoking wife, who can purchase tobacco, refusing to supply her younger husband who cannot buy it? Enforcement agencies are already under immense pressure. Are we truly expecting officers to monitor our gardens, beer gardens and private homes in search of cigarette sharing between consenting adults? Such a law invites ridicule because it is unenforceable.

History gives us a clear warning that any form of prohibition rarely eliminates demand. Instead, it often pushes it underground, where criminal networks thrive. We see it with alcohol and we have seen it with drugs. International evidence shows us what happens when you try to significantly restrict the sale of tobacco: illicit tobacco sales start showing up more, especially in communities where there are fewer legal retailers. Convenience stores in New Zealand reported increased thefts and robberies targeting tobacco products, indicating an underground demand. Customs and law enforcement in New Zealand also noted a rise in smuggling and illegal imports. When legitimate, regulated access is denied, serious illegal alternatives fill the vacuum. So I caution noble Lords as we go forward against totally believing that age restriction can and will work. I ask noble Lords to look at the core mechanism in Committee.

Funerals: Death Certificate Delays

Lord Scriven Excerpts

Thursday 3rd April 2025 Lords Chamber

[Baroness Merron (Lab)]

I am sure that we all wish to pay tribute to the memory of my noble friend’s late father. I appreciate the points that he has made. It is not the case that delays to funerals can be identified and formally linked with the changes in death certification. My noble friend raised a lot of points, many of which are valid. In a bereavement, it is more important than ever that any official processes—as well as the funeral sector itself—work as seamlessly and sensitively as possible. I assure my noble friend that not only are we driving improvement by implementing the death registration reforms but we are very focused on supporting the bereaved. On my noble friend’s point about regulation, I am not aware of any plans at present.

[Lord Scriven (LD)]

My Lords, to solve a problem, first you have to accept that it exists. Everyone involved in funerals, from the GPs doing the certification to the funeral directors, say that there is a direct link between the extra time to deal with funerals and the reforms. The reforms were needed, but can the Minister clarify the number of medical examiners required in each region—because regional variation exists—to prevent lengthy delays in funeral arrangements? What assessment have the Government made to ensure that the current number of medical examiners is sufficient to meet regional demand?

NHS Pensions

Lord Scriven Excerpts

Thursday 3rd April 2025 Lords Chamber

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

It may be helpful if I respond to the noble Lord by saying that a compensation scheme is already in place to cover direct financial losses, certain HMRC interest charges and the costs of financial and accountancy advice. On the specific point that the noble Lord raises, I will be very pleased to answer further on the response of my honourable friend in the other place.

It is also important to remember that this arises from a reform to public service pension schemes in 2014 and 2015 under the coalition Government. As part of those reforms, older pension scheme members were given protections enabling them to stay in legacy schemes, but younger members were moved on to reformed schemes. Therefore, legal cases were brought, and the Court of Appeal found against the then Government. We are dealing with an inherited situation, and we are working at pace to get the right things to people, but also in order that people do not lose out.

[Lord Scriven (LD)]

First, I have to declare an interest as a member of the NHS pension scheme. To be helpful, will the Government look at taking two urgent measures to help alleviate some of the problems that the late delivery of these statements has caused? The first is to extend the carry-forward rules from three to five years, and the second is to provide an immediate remedial service statement for those needing transitional tax-free amount certificates. If the noble Baroness cannot answer in full, a written response would be welcome.

[Baroness Merron (Lab)]

I am very glad that the noble Lord has given me that option, which I will gladly take. Perhaps it would be helpful to your Lordships’ House for me to say that the deadline to issue remedial service statements was 1 April or later. That was not achievable because of the level of technical complexity, capacity, and delays in HMT and HMRC setting out lower-level policy requirements under the previous Government, so Minister Karin Smyth extended this deadline last week and published a new timetable. Separately, 137,000 higher-earning members of the NHS pension scheme require remedial pension savings statements as part of their remedy. The deadline for that was 6 October. HMRC did not allow this to be amended. The current position is that, to date, 94,012 statements of the 137,000 have been issued. These delays are due fundamentally to the annual allowance element of the remedy being poorly designed and, again, late requirements provided by HMT and HMRC. To say that this is a knotty problem would be underestimating it.

Mental Health Bill [HL]

Lord Scriven Excerpts

Report stage
Wednesday 2nd April 2025 Lords Chamber

Supporting implementation of the Mental Health Act reforms will be a key priority of the chief inspector and I am confident that this and the wider reforms that the CQC is making progress with under the new leadership will significantly improve its effectiveness as a regulator of mental health services. Like the noble Lord, Lord Kamall, I will speak more to this point when we consider the amendment in his name in the next group.

[Lord Scriven (LD)]

Can I just ask the noble Baroness a very quick question? Will the newly appointed person have a statutory right to call for papers and witnesses from other departments to deal with mental health issues, as a commissioner would?

[Baroness Merron (Lab)]

I cannot draw a comparison with a commissioner but I will be very pleased to answer the noble Lord definitively in writing.

Secondly, as announced by the Secretary of State, we are abolishing NHS England as part of the radical reforms we are making to the national health system to rid it of duplication, inefficiency and waste, so that vital resources can be redirected to the front line. On this, we very much look forward to the much-anticipated report from Dr Penny Dash on the wider patient safety and oversight landscape. Of course, as noble Lords will be aware, the 10-year plan for the NHS is being co-developed with staff, patients and the public. I believe these changes only confirm that creating a new mental health commissioner would be not only duplicative but completely at odds with the important and very live reforms that the Government and the CQC are making.

During the course of the Bill, including today, I have heard noble Lords speak passionately about introducing a mental health commissioner role akin to that of the Children’s Commissioner. I very much value the work of the Children’s Commissioner and, as I have said before, I do not accept that it is a valid comparison. More pressingly, following a constructive meeting last week with the Children’s Commissioner, which the noble Baroness, Lady Tyler, referred to, I can report that she is concerned about the establishment of a mental health commissioner. In her view, covering all aspects of children and childhood is a critical part of her role. This is because children see their mental health as indistinguishable from their wider health and experience of childhood. We discussed this at some length. The Children’s Commissioner’s view is that the proposed establishment of a mental health commissioner risks taking a siloed approach to the barriers and challenges that children face, and I feel it is incumbent on us to listen to that view.

I also reiterate that I am deeply concerned about the level of resource needed to take this forward, as required in the amendment, as was understood by the noble Lord, Lord Kamall. This would be on top of the resources needed to remodel the healthcare quality and regulatory landscape to avoid the risk of duplication and waste. I can honestly say that I do not feel that this can be justified, particularly in the current climate.

The noble Baroness, Lady Bennett, made comparisons with the Government’s plan to introduce an Armed Forces commissioner. This is a manifesto commitment that we are certain addresses an important and specific gap: the strengthening of support for Armed Forces communities to improve service life. Furthermore, we are talking about an entirely different set of responsibilities, aimed at different set of needs in an entirely different environment. So I have to say once again that I do not believe that it is a useful comparison with respect to Amendment 47. For these reasons, I ask the noble Baroness to withdraw the amendment.

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[Baroness Fox of Buckley (Non-Afl)]

My Lords, very briefly, I will say that I absolutely support this amendment. I think it is worth clarifying what I said earlier about overdiagnosis. The danger is that that can be interpreted as meaning that I want cuts; what I actually want is targeted intervention for the right people, rather than saying, “Oh, everybody’s been calling themselves mentally ill, so let’s cut the services”.

I completely agree with the noble Baroness, Lady Tyler of Enfield, that, if we do not sort out the amount of community provision, what we have done over the last few weeks, never mind the years preceding it, will have been a waste of our time, because the Bill will not be worth the paper it is written on—that is the danger. It is very tempting, in a period of intense economic difficulties, to suggest that this might be one of the first things to go—so I do think this is a very good amendment.

I will remind the House of a discussion we had late the other evening on the plight of prisoners. If there is no community resource for people leaving prison—ex-prisoners—they will deteriorate and end up becoming very ill in the community and being incarcerated again. I discussed that in great detail. In other words, this is essential if we are serious about saying that we do not want to lock people up but, instead, want to treat them appropriately.

[Lord Scriven (LD)]

My Lords, I rise very quickly to support the amendment from the noble Lord, Lord Stevens, and have put my name to it.

I will add a couple of extra things to the noble Lord’s very well-argued case. Modest as it may be, I think it is an effective measure—and this is why I think it is and why the House should support the noble Lord’s amendment if he decides to push it to a vote. It is not that the Secretary of State has announced that the percentage will decrease next year; the percentage decrease happened during this financial year, going down from 9% to 8.78%. So we are now on a trend for the percentage of National Health Service spend on mental health.

Furthermore, one has to question the priority of the Government when they look at the national planning guidance and some of the targets that have been dropped from it. There are no plans to target the 2 million long waiters waiting for mental health care. It would be slightly disingenuous of the Minister, in response, to talk just about the mental health investment scheme, because all it refers to is ICB spend. The uniqueness and cleverness of the amendment from the noble Lord, Lord Stevens, is that it talks about all health service spend, including non-ICB spend, specialised commissioning and other elements that need to be there.

Mental health takes up 20% of illness treated by the NHS, which will probably be spending 8.7%. Because of the trend that is happening, the amendment from the noble Lord, Lord Stevens, is absolutely vital to ensure not just that the percentage is maintained but that the community facilities within this will be funded and implemented.

[Earl Howe (Con)]

My Lords, I will not speak at length, but I express my support for the case put forward by the noble Baroness, Lady Tyler, in her Amendment 50. Her concerns around the resourcing of the mental health workforce are well founded and there is no better source of evidence for those concerns than the CQC, which I thank for briefing me, very fully, on this subject at the beginning of last month.

When we look at the issue of workforce sufficiency, a paradox confronts us. Between 2019 and 2024, the mental health workforce grew by nearly 40,000 full-time equivalent staff—an increase of 35%. Yet, when we sit down to read the CQC’s recently published Monitoring the Mental Health Act in 2023/24, we find that staff shortages are a pervasive feature throughout the service. There is a cocktail of reasons for this apparent contradiction: very steeply rising patient demand; patients being admitted to hospital with a greater acuity of mental illness; a struggle in many places to recruit staff with the right skills; and poor retention of skilled staff, with, as a consequence, a high reliance on agency workers. That all impacts the quality of care given to patients, because, with hospital staff suffering burnout and temporary staff coming and going, there is often no opportunity to develop the kinds of therapeutic relationships that make patients feel psychologically safe and secure.

Of course, not all areas of the country are the same. Geographical disparities affect the availability of different skill sets, resulting in different kinds of problems manifesting themselves: for example, in one of the three high secure hospitals, the CQC encountered cases where patients were being kept in their rooms during the day. Elsewhere, on a number of in-patient wards, patients with autism or a learning disability reported that staff lacked the necessary training to look after them properly. In other settings, the lack of training is more basic: agency staff very often do not know how to operate the hospital’s IT system. This mixed picture underlines the fact that the amendment from the noble Baroness, Lady Tyler, is expressed in exactly the right way, since it mandates that biennial staff sufficiency reviews should be done not centrally but by commissioners locally.

That formula is appropriate for another reason. Depending on where you are in the country, there can be different sorts of barriers to accessing care, whether the barriers are for people from ethnic minority groups, for children and young people or simply for people living in areas of high deprivation. The more people find it difficult to access the care that they need, the more seriously they can be at risk. That particularly applies to children. The noble Baroness, Lady Bennett, made that point. We have not heard much from the Government about workforce planning generally, but this is an area where this exercise just cannot wait.

This leads me to Amendment 59, in the name of the noble Lord, Lord Stevens. It will not be much comfort to him if I say that I am right behind the sentiment of the amendment. He knows that, sadly, I cannot ask my colleagues on these Benches to vote for it, simply because I do not think it is appropriate for primary legislation to tie the hands of Government in matters of health spending. Those macro decisions surely have to be for Ministers.

Nevertheless, the flagship principle at the centre of the amendment is parity of esteem—a principle that is enshrined in statute and to which I am totally signed up, alongside, I am sure, all of your Lordships. However, parity of esteem is a broad concept and should, in my view, be measured in a range of ways, not simply by reference to monetary input, important as that is—and it is important.

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[Baroness Bennett of Manor Castle (GP)]

My Lords, I am acutely aware of the hour so I will be very brief. My Amendment 63A would provide for a duty for ICBs, local health boards and local authorities to implement preventive policies for mental disorders.

I join the noble Baroness, Lady Tyler, in regretting how the debate on this crucial Lords-starter Bill has been squeezed. However, I am in a lovely position because, in responding to the group beginning with Amendment 48, the Minister essentially supported my amendment. She said that if support can be provided much earlier, mental ill-health can be prevented. That is essentially what this amendment seeks to do.

I am obviously not going to divide the House at this stage of the evening, but I have spoken over the years to so many public health professionals, consultants and directors in local authorities, and they continually express the frustration that everyone knows that investment in preventive healthcare is the way to take pressure off the NHS. Understandably, when someone turns up with an acute mental health crisis or a broken leg, we have to treat that, and that is where the resources go.

This amendment is an attempt to write into the Bill—I hope it might be revisited in the other place—the duty of prevention. And it has to be a duty. This aligns very much with the Government’s rhetoric and their approach to public health. I will not press the amendment to a vote, but I hope this can be the start of a discussion.

[Lord Scriven (LD)]

My Lords, because of the lateness of the hour I will be very brief. These Benches support the aim of the amendment in the name of the noble Baroness, Lady Bennett of Manor Castle. It is important that, throughout all this, there is an element not just of treating the acute phase of mental ill-health but trying to ensure that prevention is there within the health service and across the whole of government, national and local. We believe on these Benches that a mental health commissioner would have been really helpful for that, as they could highlight elements that could help with prevention—but the House has made its decision on that.

I have only one question for the Minister. One of the three shifts of the Government is towards prevention. How do the Government see prevention of mental ill-health fitting into that shift, not just in NHS services but, as I said, across the whole of government, including local government, to determine how they can use their resources and levers to bring about what the noble Baroness, Lady Bennett of Manor Castle, is trying to achieve?

[Lord Kamall (Con)]

My Lords, this will probably be the last time I speak on Report—and I am sure many people are grateful for that. Before I make my last remarks, I want to put on record my gratitude to the Minister, her officials and the Whips for the amount of time they have given us in discussing a lot of these amendments. It is certainly appreciated by our side and, I am sure, by other noble Lords.

Given the time, I will not take another hour. The sentiment behind this amendment is unquestionable. During my time as Minister, I was repeatedly reminded of the need to focus on prevention, and of course I agreed to that. As we know, the noble Lord, Lord Darzi, in his report on the state of the NHS, repeated his emphasis on the shift to prevention. If we believe in parity of esteem, where possible, this should be applied to mental health.

If we can shift from a situation where we are treating patients and repeatedly detaining them, such that they are detained for longer, to a scenario where we can treat and prevent those conditions worsening, our mental health system will be better for it. I am sure that all noble Lords can agree with this. So we strongly agree with the intent here, which is in line with one of the Government’s other intentions: a shift from hospital to community.

However, when I have discussed this amendment with others, I have heard one concern that I am still reflecting on. This amendment states that ICBs, local health boards and local authorities must implement preventive policies. It has been suggested to me that this might be too prescriptive or may place a duty on smaller bodies that may not necessarily have the resources to implement such policies. Those who suggest this tell me that it may appear more reasonable to place that duty on the Secretary of State or the Department of Health and Social Care, which have the capabilities and resources to implement preventive measures. Such a policy could work if the department had to work with ICBs and local authorities, as well as local community non-state civil society organisations, to move towards preventive care. As I said, I am still reflecting on this, but I do not wish to detain the House while I make up my mind. So, with that, I look forward to the response from the Minister.